Healthcare Provider Details

I. General information

NPI: 1518145028
Provider Name (Legal Business Name): FREELAND FAMILY MEDICAL CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1689 E. MAIN ST SUITE 1
FREELAND WA
98249
US

IV. Provider business mailing address

22405 5TH PL. WEST
BOTHELL WA
98021
US

V. Phone/Fax

Practice location:
  • Phone: 360-331-4424
  • Fax: 360-331-1688
Mailing address:
  • Phone: 360-331-4424
  • Fax: 360-331-1679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WILLIAM ALAN WIEN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 360-331-4424