# WEST OLYMPIA FAMILY MEDICINE INC, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225257363
- **Authorized official:** DR. MATTHEW T. WELLOCK M.D. (OWNER)
- **Authorized official phone:** (360) 754-4837

## Contact information

- **Practice address:** 402 BLACK HILLS LN SW STE B, OLYMPIA, WA 98502-8146
- **Practice address phone:** (360) 754-4837
- **Practice address fax:** (360) 754-7304
- **Mailing address:** 1401 MARVIN RD NE STE 307 PMB 266, LACEY, WA 98516-5710
- **Mailing address phone:** (360) 491-5055
- **Mailing address fax:** (360) 491-5890

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | MD00045733 | WA | Yes |

## Other

- **Enumeration date:** 04/25/2007
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1124098 | — | WA |