Healthcare Provider Details

I. General information

NPI: 1134158348
Provider Name (Legal Business Name): FISHERS LANDING URGENT & FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SE 164TH AVE SUITE 101
VANCOUVER WA
98683
US

IV. Provider business mailing address

PO BOX 873236
VANCOUVER WA
98687
US

V. Phone/Fax

Practice location:
  • Phone: 360-882-6997
  • Fax: 360-882-4132
Mailing address:
  • Phone: 360-882-6997
  • Fax: 360-882-4132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: RONALD L KING
Title or Position: OWNER
Credential:
Phone: 360-281-7399