Provider Demographics
NPI:1306971296
Name:FRANDSEN FAMILY MEDICINE PS
Entity type:Organization
Organization Name:FRANDSEN FAMILY MEDICINE PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRANDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-876-2434
Mailing Address - Street 1:463 TREMONT ST W
Mailing Address - Street 2:STE 200
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3743
Mailing Address - Country:US
Mailing Address - Phone:360-876-2434
Mailing Address - Fax:360-876-2696
Practice Address - Street 1:463 TREMONT ST W
Practice Address - Street 2:STE 200
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-0000
Practice Address - Country:US
Practice Address - Phone:360-876-2434
Practice Address - Fax:360-876-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029864261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7134620Medicaid
WAE11640Medicare UPIN