Provider Demographics
NPI:1366247710
Name:LEWIS COUNTY PEDIATRICS AND FAMILY MEDICINE
Entity type:Organization
Organization Name:LEWIS COUNTY PEDIATRICS AND FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:MARIE TANGEN
Authorized Official - Last Name:PATANA
Authorized Official - Suffix:
Authorized Official - Credentials:PNP
Authorized Official - Phone:360-880-4955
Mailing Address - Street 1:PO BOX 708
Mailing Address - Street 2:
Mailing Address - City:NAPAVINE
Mailing Address - State:WA
Mailing Address - Zip Code:98565-0708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 A LINHART AVE NE
Practice Address - Street 2:
Practice Address - City:NAPAVINE
Practice Address - State:WA
Practice Address - Zip Code:98565-9856
Practice Address - Country:US
Practice Address - Phone:360-880-4955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care