Organization
FAMILY PHYSICIANS GROUP PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KURT LITVIN (ADMINISTRATOR)
(360) 735-8100
Entity
Organization
Contact information
Practice address
16811 SE MCGILLIVRAY BLVD, VANCOUVER, WA 98683-0400
(360) 735-8100
(360) 735-3400
Mailing address
312 SE STONE MILL DR, SUITE 160, VANCOUVER, WA 98684-3545
(360) 735-8100
(360) 735-3400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7984800
—
WA
Enumeration date
07/14/2006
Last updated
06/20/2008
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