Provider Demographics
NPI:1588091045
Name:PHYSICIANS CARE FAMILY MEDICINE, INC PS
Entity type:Organization
Organization Name:PHYSICIANS CARE FAMILY MEDICINE, INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-856-4141
Mailing Address - Street 1:1990 HOSPITAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-9315
Mailing Address - Country:US
Mailing Address - Phone:360-856-4141
Mailing Address - Fax:360-856-4145
Practice Address - Street 1:1990 HOSPITAL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-9315
Practice Address - Country:US
Practice Address - Phone:360-856-4141
Practice Address - Fax:360-856-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60401875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA900891025OtherAPPLICATION IN PROCESS