1184883449 NPI number — FAMILY HEALTH CENTERS

Table of content: (NPI 1184883449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184883449 NPI number — FAMILY HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OKANOGAN FARM WORKERS CLINIC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184883449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1340
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKANOGAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98840-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-422-5700
Provider Business Mailing Address Fax Number:
509-422-7680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 S WHITCOMB AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONASKET
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98855-9286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-486-0114
Provider Business Practice Location Address Fax Number:
509-486-0170
Provider Enumeration Date:
06/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ
Authorized Official First Name:
JESUS
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
509-422-5700

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  600625131 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 501837 . This is a "MEDICARE/OSCAR CERTIFICATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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