Healthcare Provider Details

I. General information

NPI: 1336167246
Provider Name (Legal Business Name): MCLOUGHLIN FAMILY PRACTICE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16811 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-0400
US

IV. Provider business mailing address

16811 SE MCGILLIVRAY BLVD
VANCOUVER WA
98683-0400
US

V. Phone/Fax

Practice location:
  • Phone: 360-750-3220
  • Fax: 360-735-3400
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARK MAGISTRALE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 360-750-3220