| Deer Park Family Care Clinic | |
|
905 E D St Deer Park WA 99006 | |
| (509) 276-5005 | |
| (509) 276-6785 |
| Full Name | Deer Park Family Care Clinic |
|---|---|
| Speciality | Family Medicine |
| Location | 905 E D St, Deer Park, Washington |
| Authorized Official Name and Position | Edgar A Figueroa (OWNER/PRACTICIONER) |
| Authorized Official Contact | 5092765005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Deer Park Family Care Clinic Po Box 1529 Deer Park WA 99006-1529 Ph: (509) 276-5005 | Deer Park Family Care Clinic 905 E D St Deer Park WA 99006 Ph: (509) 276-5005 |
| NPI Number | 1548294150 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 08/01/2012 |
| Medicare PECOS PAC ID | 1759271836 |
|---|---|
| Medicare Enrollment ID | O20040319001408 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548294150 | NPI | - | NPPES |
| 7085640 | Medicaid | WA | |
| 7118326 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Washington) | Primary |
| 261QR1300X | Clinic/center - Rural Health | (Washington) | Secondary |
| Provider Name | Samir Keblawi |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1790777472 PECOS PAC ID: 9739167933 Enrollment ID: I20040713001083 |
| Provider Name | Julie A Moran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558367961 PECOS PAC ID: 5496756371 Enrollment ID: I20070119000086 |
| Provider Name | Edgar A Figueroa |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487650883 PECOS PAC ID: 5395746275 Enrollment ID: I20070119000094 |
| Provider Name | Jillian R Foglesong Stabile |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518134964 PECOS PAC ID: 4284777699 Enrollment ID: I20100208000483 |
| Provider Name | Jonathan J Wilson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790959971 PECOS PAC ID: 4385805076 Enrollment ID: I20120405000076 |
| Provider Name | Naomi Nmn Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639269533 PECOS PAC ID: 8325111289 Enrollment ID: I20120813000779 |
| Provider Name | Amanda R Proctor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831850023 PECOS PAC ID: 7315331436 Enrollment ID: I20220304002078 |
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