Basic Information
| Provider Information | |||||||||
| NPI: | 1194886382 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELLEVUE FAMILY MEDICINE ASSOCIATES P.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 116TH AVE NE | ||||||||
| Address2: | SUITE #102 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254545311 | ||||||||
| FaxNumber: | 4254548188 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 116TH AVE NE | ||||||||
| Address2: | SUITE #102 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980043014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254545311 | ||||||||
| FaxNumber: | 4254548188 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 02/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | PFEIFFER | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4254545311 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MD00014573 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1508943846 | 01 | WA | NPI NUMBER | OTHER |