Basic Information
| Provider Information | |||||||||
| NPI: | 1912900234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY CARE NETWORK, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 709 W. ORCHARD | ||||||||
| Address2: | STE. 4 | ||||||||
| City: | BELLINGHAM | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603188800 | ||||||||
| FaxNumber: | 3603181085 | ||||||||
| Practice Location | |||||||||
| Address1: | 2116 E. SECTION ST. | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98274 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604281700 | ||||||||
| FaxNumber: | 3608484312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2005 | ||||||||
| LastUpdateDate: | 10/10/2017 | ||||||||
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| AuthorizedOfficialLastName: | HIPSKIND | ||||||||
| AuthorizedOfficialFirstName: | MARCY | ||||||||
| AuthorizedOfficialMiddleName: | G. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3603188800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | 602079976 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 207Q00000X | 602079976 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GAB19758 | 01 | WA | MEDICARE PTAN | OTHER |