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General NPI Number Information
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NPI Number | 1831674472
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Entity Type | Organization
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Legal Business Name | PACIFIC NORTHWEST FAMILY CARE
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Dates
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Enumeration Date | 09/29/2018
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Last Update Date | 09/29/2018
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Provider Practice Location Address
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Address Line | 4300 TALBOT RD S STE 103
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City | RENTON
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State | WA
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Zip | 98055-6238
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Country | US
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Telephone | 253-686-1766
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Fax |
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Provider Business Mailing Address
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Address Line | 325 WASHINGTON AVE S STE 135
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City | KENT
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State | WA
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Zip | 98032-5767
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Country | US
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Telephone | 206-582-8186
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. CHRISTOPHER THOMAS MATTHEWS
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Credential | DBA, ARNP, FNP-BC
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Telephone | 253-686-1766
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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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