Basic Information
| Provider Information | |||||||||
| NPI: | 1619189347 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY CARE NETWORK PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SPADY MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 W ORCHARD DRIVE | ||||||||
| Address2: | SUITE4 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982250066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603189705 | ||||||||
| FaxNumber: | 3603181085 | ||||||||
| Practice Location | |||||||||
| Address1: | 407 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | EVERSON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3609663441 | ||||||||
| FaxNumber: | 3609662032 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 06/26/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HIPSKIND | ||||||||
| AuthorizedOfficialFirstName: | MARCY | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | FAMILY CARE NETWORK PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3603189705 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FAMILY CARE NETWORK PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | Y | Managed Care Organizations | Health Maintenance Organization |
ID Information
| ID | Type | State | Issuer | Description | 7591605 | 05 | WA | MEDICAID |