| Edmonds Family Care, Pllc | |
|
6101 200th St Sw Ste#208 Lynnwood WA 98036-6077 | |
| (425) 775-2066 | |
| (425) 775-5306 |
| Full Name | Edmonds Family Care, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 6101 200th St Sw, Lynnwood, Washington |
| Authorized Official Name and Position | Svetlana A Bugaichuk (OFFICE MANAGER) |
| Authorized Official Contact | 4257752066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edmonds Family Care, Pllc 6101 200th St Sw Ste#208 Lynnwood WA 98036-6077 Ph: (425) 775-2066 | Edmonds Family Care, Pllc 6101 200th St Sw Ste#208 Lynnwood WA 98036-6077 Ph: (425) 775-2066 |
| NPI Number | 1184751638 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 11/08/2021 |
| Medicare PECOS PAC ID | 7810929957 |
|---|---|
| Medicare Enrollment ID | O20050908001234 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184751638 | NPI | - | NPPES |
| 7128606 | Medicaid | WA | |
| 0199257 | Other | WA | LABOR&INDUSTRIES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 602496426 (Washington) | Primary |
| Provider Name | Tanya I Bryant |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194739987 PECOS PAC ID: 8729010863 Enrollment ID: I20050908001242 |
| Provider Name | Dina Victorovna Shepelyuk |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407428097 PECOS PAC ID: 1951792258 Enrollment ID: I20211221001921 |
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