NPIMap

Organization Active NPI

Physicians Care Family Medicine Inc PS

  • Family Medicine Physician
  • Sedro Woolley, WA
National Provider Identifier
1396802492
Registry record updated Aug 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PHYSICIANS CARE FAMILY MEDICINE INC PS
Practice address
1990 Hospital Drive
Suite 100
Sedro Woolley, WA 98284-9315
Phone
(360) 856-4141
Fax
(360) 856-4145
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2007

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

Authorized official

Name
Herbert Edwin Stickle, M.D.
Title
Adminstrator
Phone
(360) 856-4141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X WA Primary

Addresses

Primary practice location

1990 Hospital Drive
Suite 100
Sedro Woolley, WA 98284-9315

Mailing address

1990 Hospital Drive
Suite 100
Sedro Woolley, WA 98284-9315
Phone (360) 856-4141

Other identifiers 2

IdentifierTypeStateIssuer
7080559MedicaidWA
47990OtherWALABOR & INDUSTRIES

Other names 1

  • Dietrich & Smith Clinic, Inc Former legal business name

National Provider Directory

National Provider Directory

Locations

2241 Hospital Dr
Sedro Woolley, WA 98284
Phone (360) 856-4141

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185926400000",
    "number": "1396802492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 HOSPITAL DRIVE",
            "address_2": "SUITE 100",
            "city": "SEDRO WOOLLEY",
            "state": "WA",
            "postal_code": "982849315",
            "telephone_number": "360-856-4141",
            "fax_number": "360-856-4145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 HOSPITAL DRIVE",
            "address_2": "SUITE 100",
            "city": "SEDRO WOOLLEY",
            "state": "WA",
            "postal_code": "982849315",
            "telephone_number": "360-856-4141",
            "fax_number": "360-856-4145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICIANS CARE FAMILY MEDICINE INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-08-01",
        "status": "A",
        "authorized_official_last_name": "STICKLE",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "EDWIN",
        "authorized_official_title_or_position": "ADMINSTRATOR",
        "authorized_official_telephone_number": "360-856-4141",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7080559",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "47990",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dietrich & Smith Clinic, Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Sedro Woolley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; 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.