=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447607478
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GIG HARBOR PRIMARY CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2016
-----------------------------------------------------
Last Update Date | 01/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4423 POINT FOSDICK DR NW SUITE 306
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-1797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-432-4437
-----------------------------------------------------
Fax | 866-336-4138
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4423 POINT FOSDICK DR NW SUITE 306
-----------------------------------------------------
City | GIG HARBOR
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98335-1797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-432-4437
-----------------------------------------------------
Fax | 866-336-4138
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CLINICAL OPERATIONS
-----------------------------------------------------
Name | MS. JESSICA HOPKINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 253-432-4437
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------