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Organization
VALLEY ROOTS FAMILY CARE PLLC
Active
Organization
VALLEY ROOTS FAMILY CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA THOMAS (OFFICE MANAGER)
(360) 428-1884
Entity
Organization
Contact information
Practice address
617 W. DIVISION ST., MOUNT VERNON, WA 98273
(360) 428-1884
(360) 428-1889
Mailing address
617 W. DIVISION ST., MOUNT VERNON, WA 98273
(360) 428-1884
(360) 428-1889
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00040349
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0220687
LABOR AND INDUSTRIES
WA
05
—
2076241
—
WA
05
—
8457228
—
WA
Enumeration date
11/11/2015
Last updated
12/21/2021
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