Provider Demographics
NPI:1396899340
Name:FAMILY PRACTICE ASSOCIATES OF OLYMPIA, PLLC
Entity type:Organization
Organization Name:FAMILY PRACTICE ASSOCIATES OF OLYMPIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:EDKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-459-3663
Mailing Address - Street 1:3525 ENSIGN RD NE STE R
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5065
Mailing Address - Country:US
Mailing Address - Phone:360-459-3663
Mailing Address - Fax:360-413-0921
Practice Address - Street 1:3525 ENSIGN RD NE STE R
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-459-3663
Practice Address - Fax:360-413-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601961208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7096522Medicaid
WAAB09845Medicare ID - Type Unspecified