NPIMap

Organization Active NPI

Castle Rock Pediatrics and Family Wellness Center

  • Multi-Specialty Clinic/Center
  • Castle Rock, WA
National Provider Identifier
1770767477
Registry record updated Nov 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
601 929 001 11 Issued in WA
Legal business name
CASTLE ROCK PEDIATRICS AND FAMILY WELLNESS CENTER
Practice address
139 First Avenue SW
Castle Rock, WA 98611-0160
Phone
(360) 274-2353
Fax
(360) 274-2354
NPI assigned
Dec 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2008

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

Authorized official

Name
Mrs. Reinhild AyoubNPI 1730126277
Title
Owner/Practitioner
Phone
(360) 274-2353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X 601 929 001 11 WA Primary

Addresses

Primary practice location

139 First Avenue SW
Castle Rock, WA 98611-0160

Mailing address

PO Box 160
Castle Rock, WA 98611-0160
Phone (360) 274-2353

Other identifiers 1

IdentifierTypeStateIssuer
7094261MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1197936000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1227571200000",
    "number": "1770767477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "986110160",
            "telephone_number": "360-274-2353",
            "fax_number": "360-274-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 FIRST AVENUE SW",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "986110160",
            "telephone_number": "360-274-2353",
            "fax_number": "360-274-2354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASTLE ROCK PEDIATRICS AND FAMILY WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-18",
        "last_updated": "2008-11-25",
        "status": "A",
        "authorized_official_last_name": "AYOUB",
        "authorized_official_first_name": "REINHILD",
        "authorized_official_title_or_position": "OWNER/PRACTITIONER",
        "authorized_official_telephone_number": "360-274-2353",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WA",
            "license": "601 929 001 11",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7094261",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Castle Rock, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.