| Heritage Family Medicine | |
|
4001 Harrison Ave Nw Ste 101 Olympia WA 98502-5084 | |
| (360) 704-2362 | |
| (360) 350-1445 |
| Full Name | Heritage Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 4001 Harrison Ave Nw Ste 101, Olympia, Washington |
| Authorized Official Name and Position | Richard Louis Faiola (OWNER) |
| Authorized Official Contact | 3607042362 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heritage Family Medicine 4001 Harrison Ave Nw Olympia WA 98502-5084 Ph: (360) 704-2362 | Heritage Family Medicine 4001 Harrison Ave Nw Ste 101 Olympia WA 98502-5084 Ph: (360) 704-2362 |
| NPI Number | 1427136977 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 03/26/2021 |
| Medicare PECOS PAC ID | 8628084712 |
|---|---|
| Medicare Enrollment ID | O20060227000613 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427136977 | NPI | - | NPPES |
| 6220HE | Other | WA | GROUP RIDER |
| 0219928 | Other | WA | LABOR AND INDUSTRIES WA |
| 7136914 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Richard L Faiola |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1689626392 PECOS PAC ID: 0345256434 Enrollment ID: I20060227000638 |
| Provider Name | Lynda B Stafford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629021852 PECOS PAC ID: 9032120472 Enrollment ID: I20060522000005 |
| Provider Name | Debra S Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619289485 PECOS PAC ID: 3779779038 Enrollment ID: I20101129000473 |
| Provider Name | Elizabeth M Forman Serdar |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629325204 PECOS PAC ID: 5799937496 Enrollment ID: I20130213000589 |
| Provider Name | Amandeep K Mann |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669914354 PECOS PAC ID: 6103195789 Enrollment ID: I20170713001966 |
| Provider Name | Percy Lee Lynchard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881108553 PECOS PAC ID: 0244598472 Enrollment ID: I20171218001452 |
| Provider Name | Sofia Yurjevna Kolesnikova |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851953855 PECOS PAC ID: 9931437035 Enrollment ID: I20190828000891 |
| Provider Name | Samantha Renee Marie Reese |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639765316 PECOS PAC ID: 0547677502 Enrollment ID: I20210318002860 |
| Provider Name | James Andrew Hrncir |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194420711 PECOS PAC ID: 0547620858 Enrollment ID: I20230718004172 |
| Provider Name | Abril Henry |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770263097 PECOS PAC ID: 9537521364 Enrollment ID: I20230810003874 |
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