Pb Primary Care Clinic Llc | |
34617 11th Pl S Ste 204 Federal Way WA 98003-8706 | |
(253) 874-8445 | |
(253) 874-2085 |
Full Name | Pb Primary Care Clinic Llc |
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Speciality | Clinic/Center |
Location | 34617 11th Pl S Ste 204, Federal Way, Washington |
Authorized Official Name and Position | Philip Buenvenida (OWNER) |
Authorized Official Contact | 2538748445 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Pb Primary Care Clinic Llc 34617 11th Pl S Ste 204 Federal Way WA 98003-8706 Ph: (253) 874-8445 | Pb Primary Care Clinic Llc 34617 11th Pl S Ste 204 Federal Way WA 98003-8706 Ph: (253) 874-8445 |
NPI Number | 1346567666 |
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Provider Enumeration Date | 04/26/2010 |
Last Update Date | 05/01/2024 |
Medicare PECOS PAC ID | 3274763628 |
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Medicare Enrollment ID | O20140304000247 |
Identifier | Type | State | Issuer |
---|---|---|---|
1346567666 | NPI | - | NPPES |
1050640 | Medicaid | WA | |
000109367 | Other | WA | MEDICARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Philip N Buenvenida |
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Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1386660579 PECOS PAC ID: 4486811742 Enrollment ID: I20120130000429 |
Provider Name | Ma Isabel Obligacion |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1760017115 PECOS PAC ID: 5991129363 Enrollment ID: I20200717000720 |
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