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General NPI Number Information
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NPI Number | 1093636185
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Entity Type | Organization
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Legal Business Name | FOUNDATION FAMILY MEDICINE
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Dates
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Enumeration Date | 07/23/2026
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Last Update Date | 07/23/2026
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Provider Practice Location Address
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Address Line | 28124 N SHORT RD
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City | DEER PARK
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State | WA
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Zip | 99006-9777
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Country | US
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Telephone | 509-990-8986
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Fax |
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Provider Business Mailing Address
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Address Line | 28124 N SHORT RD
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City | DEER PARK
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State | WA
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Zip | 99006-9777
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Country | US
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Telephone | 509-990-8986
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT/OWNER
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Name | JOSEPH P KREILKAMP
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Credential | PA-C
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Telephone | 509-990-8986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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