MEDICARE: PENINSULA INTERNAL MEDICINE ASSOCIATES PS

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	207R00000X	Internal Medicine Physician	601201408	WA
2	207RN0300X	Nephrology Physician	601201408	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205803723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENINSULA INTERNAL MEDICINE ASSOCIATES PS

Provider Business Mailing Address
First Line	:	4423 POINT FOSDICK DR NW
Second Line	:	SUITE 200-A
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1797
Country	:	US
Telephone Number	:	253-853-2702
Fax Number	:	253-853-2833

Provider Business Practice Location Address
First Line	:	4423 POINT FOSDICK DR NW
Second Line	:	SUITE 200-A
City	:	GIG HARBOR
State	:	WA
Zip	:	98335-1797
Country	:	US
Telephone Number	:	253-853-2702
Fax Number	:	253-853-2833

Authorized Official
Title or Position	:	MGR
Name	:	CAROL MC FARLAND
Credential	:
Telephone Number	:	253-858-0783

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	07/17/2008

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Directions to “PENINSULA INTERNAL MEDICINE ASSOCIATES PS ” Practice Location

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