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PINE FAMILY PRACTICE LLC NPI 1770063968


NPI Information

NPI: 1770063968
Provider Name: PINE FAMILY PRACTICE LLC
Classification: Physician Assistant - 363A00000X
Entity Type: Organization

CLIA Number: 50D2152596

Address:
2240 E LINCOLN AVE
SUNNYSIDE, WA
ZIP 98944
Phone: (509) 836-2367
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PINE FAMILY PRACTICE LLC is a physician assistant in Sunnyside, WA. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. PINE FAMILY PRACTICE LLC NPI is 1770063968. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2240 E LINCOLN AVE
SUNNYSIDE, WA
ZIP 98944-487
Phone: (509) 836-2367
Fax: (855) 784-6425

The provider's authorized official is Mary Pine .
The authorized official title is Owner/provider and has the following contact phone number (509) 778-2703.

The CLIA number assigned to this NPI record is 50D2152596 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/16/2018 and was last updated on 11/7/2018.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363A00000XPhysician Assistant1004660WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
18541989MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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