=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649409186
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FAMILY HEALTH CENTERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2009
-----------------------------------------------------
Last Update Date | 01/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 NORTH SIXTH STREET
-----------------------------------------------------
City | BREWSTER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-689-3789
-----------------------------------------------------
Fax | 509-689-7647
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1340
-----------------------------------------------------
City | OKANOGAN
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98840-1340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-422-5700
-----------------------------------------------------
Fax | 509-422-7680
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JESUS HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 509-422-5700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 600-625-131-3
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------