Basic Information
| Provider Information | |||||||||
| NPI: | 1861708281 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SWEDISH EDMONDS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BIRTH AND FAMILY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21911 76TH AVE W. | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256404950 | ||||||||
| FaxNumber: | 4256404455 | ||||||||
| Practice Location | |||||||||
| Address1: | 21911 76TH AVE W | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980267507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256404950 | ||||||||
| FaxNumber: | 4256404903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2010 | ||||||||
| LastUpdateDate: | 12/22/2011 | ||||||||
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| AuthorizedOfficialLastName: | CANNING | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | V.P. FINANCIAL OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2062153353 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SWEDISH EDMONDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.