| Valley Roots Family Care Pllc | |
|
617 W. Division St. Mount Vernon WA 98273 | |
| (360) 428-1884 | |
| (360) 428-1889 |
| Full Name | Valley Roots Family Care Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 617 W. Division St., Mount Vernon, Washington |
| Authorized Official Name and Position | Tara Thomas (OFFICE MANAGER) |
| Authorized Official Contact | 3604281884 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Valley Roots Family Care Pllc 617 W. Division St. Mount Vernon WA 98273 Ph: (360) 428-1884 | Valley Roots Family Care Pllc 617 W. Division St. Mount Vernon WA 98273 Ph: (360) 428-1884 |
| NPI Number | 1144693250 |
|---|---|
| Provider Enumeration Date | 11/11/2015 |
| Last Update Date | 12/21/2021 |
| Medicare PECOS PAC ID | 8022311869 |
|---|---|
| Medicare Enrollment ID | O20160128000515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144693250 | NPI | - | NPPES |
| 0220687 | Other | WA | LABOR AND INDUSTRIES |
| 2076241 | Medicaid | WA | |
| 8457228 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | MD00040349 (Washington) | Primary |
| Provider Name | David B Benson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629057278 PECOS PAC ID: 6002810348 Enrollment ID: I20060829000398 |
| Provider Name | Christina M Jepperson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285023028 PECOS PAC ID: 7517283534 Enrollment ID: I20150309002518 |
| Provider Name | Coralie Sophie Meslin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124516455 PECOS PAC ID: 0840533741 Enrollment ID: I20190516001062 |
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