Provider Demographics
NPI:1346063773
Name:FASA FAMILY WELLNESS PLLC
Entity type:Organization
Organization Name:FASA FAMILY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:HESS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:360-754-3338
Mailing Address - Street 1:PO BOX 825159
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-5159
Mailing Address - Country:US
Mailing Address - Phone:866-626-1540
Mailing Address - Fax:
Practice Address - Street 1:2400 RACQUET LN
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-6109
Practice Address - Country:US
Practice Address - Phone:509-225-3668
Practice Address - Fax:509-225-3448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical