Healthcare Provider Details

I. General information

NPI: 1245338227
Provider Name (Legal Business Name): RIDGEFIELD FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 12/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8507 SOUTH 5TH STREET SUITE 113
RIDGEFIELD WA
98642
US

IV. Provider business mailing address

PO BOX 8904
VANCOUVER WA
98668-8904
US

V. Phone/Fax

Practice location:
  • Phone: 360-887-9494
  • Fax: 360-887-9498
Mailing address:
  • Phone: 360-887-9494
  • Fax: 360-887-9498

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: SHARON ANN HOUGHTON
Title or Position: CLINIC MANAGER
Credential:
Phone: 360-887-9494