| Russell W Faria Do Pc | |
|
15215 Se 272nd St Ste 103 Kent WA 98042-4215 | |
| (253) 639-1883 | |
| (253) 639-1891 |
| Full Name | Russell W Faria Do Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 15215 Se 272nd St Ste 103, Kent, Washington |
| Authorized Official Name and Position | Trish Bukauskas (BILLING MGR) |
| Authorized Official Contact | 8432939966 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Russell W Faria Do Pc 15215 Se 272nd St Ste 103 Kent WA 98042-4215 Ph: (253) 639-1883 | Russell W Faria Do Pc 15215 Se 272nd St Ste 103 Kent WA 98042-4215 Ph: (253) 639-1883 |
| NPI Number | 1457521619 |
|---|---|
| Provider Enumeration Date | 03/04/2008 |
| Last Update Date | 03/04/2008 |
| Medicare PECOS PAC ID | 5496831786 |
|---|---|
| Medicare Enrollment ID | O20080327000012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457521619 | NPI | - | NPPES |
| 150278 | Medicaid | OR | |
| D020354 | Other | OR | LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | D020354 (Oregon) | Primary |
| Provider Name | Russell W Faria |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114901113 PECOS PAC ID: 0042301798 Enrollment ID: I20070809000289 |
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