Healthcare Provider Details

I. General information

NPI: 1093636185
Provider Name (Legal Business Name): FOUNDATION FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28124 N SHORT RD
DEER PARK WA
99006-9777
US

IV. Provider business mailing address

28124 N SHORT RD
DEER PARK WA
99006-9777
US

V. Phone/Fax

Practice location:
  • Phone: 509-990-8986
  • Fax:
Mailing address:
  • Phone: 509-990-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH P KREILKAMP
Title or Position: PHYSICIAN ASSISTANT/OWNER
Credential: PA-C
Phone: 509-990-8986