| Vmc Fairwood Primary Care | |
|
14410 Se Petrovitsky Rd Suite 104 Renton WA 98058-8900 | |
| (425) 656-4242 | |
| Not Available |
| Full Name | Vmc Fairwood Primary Care |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 14410 Se Petrovitsky Rd, Renton, Washington |
| Authorized Official Name and Position | Melissa Farley (TECHNICAL COORDINATOR) |
| Authorized Official Contact | 4259176282 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vmc Fairwood Primary Care 3600 Lind Ave Sw Suite 100 Renton WA 98055-4934 Ph: (425) 656-5412 | Vmc Fairwood Primary Care 14410 Se Petrovitsky Rd Suite 104 Renton WA 98058-8900 Ph: (425) 656-4242 |
| NPI Number | 1649227380 |
|---|---|
| Provider Enumeration Date | 05/28/2006 |
| Last Update Date | 01/15/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649227380 | NPI | - | NPPES |
| 7095839 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
| 363AM0700X | Physician Assistant - Medical | (* (Not Available)) | Secondary |
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