West Olympia Family Medicine Inc, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD00045733 Issued in WA

Legal business name

WEST OLYMPIA FAMILY MEDICINE INC, PC

Practice address

402 Black Hills LN SW Ste B
Olympia, WA 98502-8146

Phone

(360) 754-4837

Fax

(360) 754-7304

NPI assigned

Apr 25, 2007

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Matthew T. Wellock, M.D.

Title

Owner

Phone

(360) 754-4837

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Randy L Buckner, D.O.

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1841207792
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1225257363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 MARVIN RD NE STE 307 PMB 266",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985165710",
            "telephone_number": "360-491-5055",
            "fax_number": "360-491-5890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "402 BLACK HILLS LN SW STE B",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028146",
            "telephone_number": "360-754-4837",
            "fax_number": "360-754-7304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST OLYMPIA FAMILY MEDICINE INC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-25",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "WELLOCK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-754-4837",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00045733",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124098",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Marie Wertz, LMP
• Laura Ann Wesen, LMP
• Jaiza Wesley
• Samantha J Wesley, AAC
• West Coast Prosthetics and Orthotics, LLC
• West Olympia Internal Medicine PLLC
• West Olympia Pharmacy
• West Olympia Pharmacy
• West Olympia Psychiatry PLLC (Mary Schroeder ARNP)
• West Thurston Regional Fire Protection Service Authority (West Thurston Regional Fire Authority)

• Family Medicine Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.