| Organization Name: | FAMILY MEDICINE NEWPORT |
| NPI Number: | 1013108638 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TOM WILBUR (CEO) |
| Mailing Address: | 714 W Pine St Newport |
| State: | WA US |
| Postal Code: | 991569046 |
| Phone Number: | 5094472441 |
| Fax Number: | 5094470456 |
| NPI Enumeration Date: | 08/08/2007 |
| NPI Last Update Date: | 08/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 264000780-001-0002 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |