Provider Demographics
NPI:1952746026
Name:KIRKPATRICK FAMILY CARE, PS
Entity Type:Organization
Organization Name:KIRKPATRICK FAMILY CARE, PS
Other - Org Name:KIRKPATRICK FAMILY CARE FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-423-9580
Mailing Address - Street 1:PO BOX 1338
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-7785
Mailing Address - Country:US
Mailing Address - Phone:360-575-9161
Mailing Address - Fax:360-575-9306
Practice Address - Street 1:783 COMMERCE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2450
Practice Address - Country:US
Practice Address - Phone:360-575-9161
Practice Address - Fax:360-575-9161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIRKPATRICK FAMILY CARE, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-02
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60062282213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1447286646OtherMEDICRE NPI