Healthcare Provider Details

I. General information

NPI: 1376268680
Provider Name (Legal Business Name): AUSINK FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W ORCHARD AVE STE 200
SELAH WA
98942-1329
US

IV. Provider business mailing address

105 W ORCHARD AVE STE 200
SELAH WA
98942-1329
US

V. Phone/Fax

Practice location:
  • Phone: 509-698-2520
  • Fax: 509-698-2558
Mailing address:
  • Phone: 509-698-2520
  • Fax: 509-698-2558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY R AUSINK
Title or Position: OWNER
Credential: PA-C
Phone: 509-698-2520