Provider Demographics
NPI:1154699924
Name:PRIMARY CARE REDMOND, PLLC
Entity type:Organization
Organization Name:PRIMARY CARE REDMOND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VAN HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-895-8600
Mailing Address - Street 1:8301 161ST AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3858
Mailing Address - Country:US
Mailing Address - Phone:425-895-8600
Mailing Address - Fax:
Practice Address - Street 1:8301 161ST AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3858
Practice Address - Country:US
Practice Address - Phone:425-895-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004449261QP2300X
WAAP30001935261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497737316OtherINDIVIDUAL NPI
1588676001OtherINDIVIDUAL NPI
WAAB17259OtherWA MEDICARE NUMBER
WA8850455OtherWA MEDICARE NUMBER
1588676001OtherINDIVIDUAL NPI
PO5149Medicare UPIN