MEDICARE: AUSINK FAMILY MEDICINE LLC

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	261Q00000X	Clinic/Center
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	604968950	OTHER	WA	BUSINESS LICENSE

General Provider Information

NPI Number	:	1376268680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUSINK FAMILY MEDICINE LLC

Provider Business Mailing Address
First Line	:	105 W ORCHARD AVE STE 200
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-1329
Country	:	US
Telephone Number	:	509-698-2520
Fax Number	:	509-698-2558

Provider Business Practice Location Address
First Line	:	105 W ORCHARD AVE STE 200
Second Line	:
City	:	SELAH
State	:	WA
Zip	:	98942-1329
Country	:	US
Telephone Number	:	509-698-2520
Fax Number	:	509-698-2558

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY R AUSINK
Credential	:	PA-C
Telephone Number	:	509-698-2520

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	02/03/2025

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Directions to “AUSINK FAMILY MEDICINE LLC ” Practice Location

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