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1003863663

NPI Code Detail

MEDICARE: DR. KELLIE L. JACOBS MD

MEDICARE: DR. KELLIE L. JACOBS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD00028253	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	080148055	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	423898022	OTHER	WA	GROUP HEALTH COOPERATIVE
3	0130079	OTHER	WA	LABOR & INDUSTRIES (REG)
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	14535	OTHER	WA	REGENCE BLUESHIELD
6	8925030	OTHER	WA	LABOR & INDUSTRIES (CV)

General Provider Information

NPI Number	:	1003863663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLIE L. JACOBS MD

Provider Business Mailing Address
First Line	:	709 W ORCHARD DR
Second Line	:	SUITE 4
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1766
Country	:	US
Telephone Number	:	360-318-8800
Fax Number	:	360-318-1085

Provider Business Practice Location Address
First Line	:	3500 ORCHARD PL
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-1749
Country	:	US
Telephone Number	:	360-671-3900
Fax Number	:	360-647-0882

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/24/2012

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Directions to “ DR. KELLIE L. JACOBS MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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