Provider Demographics
NPI:1982639506
Name:BURLINGTON FAMILY PRACTICE PLLP
Entity type:Organization
Organization Name:BURLINGTON FAMILY PRACTICE PLLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-755-0641
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-0329
Mailing Address - Country:US
Mailing Address - Phone:360-755-0641
Mailing Address - Fax:360-755-1405
Practice Address - Street 1:835 E FAIRHAVEN AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-0329
Practice Address - Country:US
Practice Address - Phone:360-755-0641
Practice Address - Fax:360-755-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7082860Medicaid
WA7082860Medicaid