Provider Demographics
NPI:1538504774
Name:PACIFIC PRIMARY CARE - SEQUIM INC
Entity type:Organization
Organization Name:PACIFIC PRIMARY CARE - SEQUIM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEPRATI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-582-2690
Mailing Address - Street 1:800 N 5TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3045
Mailing Address - Country:US
Mailing Address - Phone:360-582-2690
Mailing Address - Fax:
Practice Address - Street 1:800 N 5TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3045
Practice Address - Country:US
Practice Address - Phone:360-582-2690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty