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General NPI Number Information
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NPI Number | 1184751638
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Entity Type | Organization
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Legal Business Name | EDMONDS FAMILY CARE, PLLC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 6101 200TH ST SW STE#208
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City | LYNNWOOD
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State | WA
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Zip | 98036-6077
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Country | US
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Telephone | 425-775-2066
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Fax | 425-775-5306
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Provider Business Mailing Address
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Address Line | 6101 200TH ST SW STE#208
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City | LYNNWOOD
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State | WA
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Zip | 98036-6077
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Country | US
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Telephone | 425-775-2066
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Fax | 425-775-5306
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SVETLANA A BUGAICHUK
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Credential |
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Telephone | 425-775-2066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 602496426
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License Number State | WA
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