Healthcare Provider Details

I. General information

NPI: 1558567222
Provider Name (Legal Business Name): HARBOR FAMILY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 04/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ALDER ST
SOUTH BEND WA
98586
US

IV. Provider business mailing address

PO BOX 227
SOUTH BEND WA
98586-0227
US

V. Phone/Fax

Practice location:
  • Phone: 360-875-5339
  • Fax: 360-875-5042
Mailing address:
  • Phone: 360-875-5339
  • Fax: 360-875-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00020716
License Number StateWA

VIII. Authorized Official

Name: DR. FRANK A HING
Title or Position: PRESIDENT, OWNER
Credential: MD
Phone: 360-875-5339