NPIMap

Organization Active NPI

Fairhaven Family Medicine PS

  • Multi-Specialty Clinic/Center
  • Burlington, WA
National Provider Identifier
1740425685
Registry record updated Sep 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
MD00013642 Issued in WA
Legal business name
FAIRHAVEN FAMILY MEDICINE PS
Practice address
1030 E Fairhaven Ave
Burlington, WA 98233-2006
Phone
(360) 755-0311
Fax
(360) 755-1272
NPI assigned
Dec 5, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2010

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

Authorized official

Name
Dr. Stephen M Aldrich, M.D.
Title
Owner/Physician
Phone
(360) 755-0311

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X MD00013642 WA Primary
Multi-Specialty Clinic/Center 261QM1300X MD00023548 WA

Addresses

Primary practice location

1030 E Fairhaven Ave
Burlington, WA 98233-2006

Mailing address

PO Box 468
Burlington, WA 98233-0468
Phone (360) 755-0311

Other identifiers 1

IdentifierTypeStateIssuer
S57930OtherWAREGENCE BLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1228435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284508800000",
    "number": "1740425685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 468",
            "city": "BURLINGTON",
            "state": "WA",
            "postal_code": "982330468",
            "telephone_number": "360-755-0311",
            "fax_number": "360-755-1272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 E FAIRHAVEN AVE",
            "city": "BURLINGTON",
            "state": "WA",
            "postal_code": "982332006",
            "telephone_number": "360-755-0311",
            "fax_number": "360-755-1272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHAVEN FAMILY MEDICINE PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-05",
        "last_updated": "2010-09-15",
        "status": "A",
        "authorized_official_last_name": "ALDRICH",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "360-755-0311",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WA",
            "license": "MD00013642",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WA",
            "license": "MD00023548",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "S57930",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burlington, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2010; 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.