NPIMap

Organization Active NPI

Yakima Valley Professional Services on Tieton, PC

  • Clinic/Center
  • Yakima, WA
National Provider Identifier
1760411912
Registry record updated Aug 19, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
MD00027321 Issued in WA
Legal business name
YAKIMA VALLEY PROFESSIONAL SERVICES ON TIETON, PC
Doing business as
Pacific Crest Family Medicine
Practice address
311 S. 72ND Ave
Yakima, WA 98908
Phone
(509) 972-1818
Fax
(509) 972-7842
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2010

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

Authorized official

Name
Jim Simmons
Title
Director of Finance
Phone
(509) 248-7849

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MD00027321 WA Primary

Addresses

Primary practice location

311 S. 72ND Ave
Yakima, WA 98908

Mailing address

PO Box 2947
Yakima, WA 98907-2947
Phone (509) 248-7849

Other identifiers 1

IdentifierTypeStateIssuer
7091168MedicaidWA

Other names 1

  • Pacific Crest Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Medical Associates of Yakima LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

620 North Park Dr
Selah, WA 98942
Phone (509) 697-5511

3909 Creekside Loop
Ste 115
Yakima, WA 98902
Phone (509) 574-6095

101 N 65th Ave
Yakima, WA 98908
Phone (509) 248-3263

102 S 72ND Ave Ste 102
Yakima, WA 98908

3909 Creekside Loop
Yakima, WA 98902
Phone (509) 248-7520

402 S 12th Ave
Yakima, WA 98902
Phone (509) 248-3263

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282176000000",
    "number": "1760411912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2947",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989072947",
            "telephone_number": "509-248-7849",
            "fax_number": "509-249-5042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 S. 72ND AVE",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "98908",
            "telephone_number": "509-972-1818",
            "fax_number": "509-972-7842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YAKIMA VALLEY PROFESSIONAL SERVICES ON TIETON, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2010-08-19",
        "status": "A",
        "authorized_official_last_name": "SIMMONS",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "509-248-7849"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "MD00027321",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7091168",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Crest Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 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.