Provider Demographics
NPI:1194886382
Name:BELLEVUE FAMILY MEDICINE ASSOCIATES P.S.
Entity type:Organization
Organization Name:BELLEVUE FAMILY MEDICINE ASSOCIATES P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-454-5311
Mailing Address - Street 1:1600 116TH AVE NE
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3014
Mailing Address - Country:US
Mailing Address - Phone:425-454-5311
Mailing Address - Fax:425-454-8188
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:SUITE #102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3014
Practice Address - Country:US
Practice Address - Phone:425-454-5311
Practice Address - Fax:425-454-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1508943846OtherNPI NUMBER
WAF73171Medicare UPIN
WAA07520Medicare UPIN
WA1508943846OtherNPI NUMBER
WAA05576Medicare UPIN