Provider Demographics
NPI:1952436339
Name:PACIFIC PRIMARY CARE PC
Entity Type:Organization
Organization Name:PACIFIC PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASMA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-582-1176
Mailing Address - Street 1:530 W FIR ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3284
Mailing Address - Country:US
Mailing Address - Phone:360-582-1176
Mailing Address - Fax:888-316-0903
Practice Address - Street 1:530 W FIR ST
Practice Address - Street 2:SUITE C
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3284
Practice Address - Country:US
Practice Address - Phone:360-582-1176
Practice Address - Fax:888-316-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602172797261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADA5471OtherRAIL ROAD MEDICARE
WA0159038OtherLABOR AND INDUSTRIES
WA7121056Medicaid
WADA5471OtherRAIL ROAD MEDICARE