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VALLEY ROOTS FAMILY CARE PLLC NPI 1144693250


NPI Information

NPI: 1144693250
Provider Name: VALLEY ROOTS FAMILY CARE PLLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization

CLIA Number: 50D2105877

Address:
617 W. DIVISION ST.
MOUNT VERNON, WA
ZIP 98273
Phone: (360) 428-1884
Get Directions

VALLEY ROOTS FAMILY CARE PLLC is a family medicine in Mount Vernon, WA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. VALLEY ROOTS FAMILY CARE PLLC NPI is 1144693250. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

617 W. DIVISION ST.
MOUNT VERNON, WA
ZIP 98273
Phone: (360) 428-1884
Fax: (360) 428-1889

The provider's authorized official is Tara Thomas .
The authorized official title is Office Manager and has the following contact phone number (360) 428-1884.

The CLIA number assigned to this NPI record is 50D2105877 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/11/2015 and was last updated on 12/21/2021.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineMD00040349WASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
18457228MEDICAIDWASHINGTON
20220687OTHERWASHINGTONLABOR AND INDUSTRIES
32076241MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.