Provider Demographics
NPI:1679621759
Name:GENERAL HEALTHCARE, PS
Entity type:Organization
Organization Name:GENERAL HEALTHCARE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:BINQIU
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-973-9328
Mailing Address - Street 1:4709 MEMORY LN. W.
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-973-9328
Mailing Address - Fax:253-566-4982
Practice Address - Street 1:4709 MEMORY LN W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-1038
Practice Address - Country:US
Practice Address - Phone:253-973-9328
Practice Address - Fax:253-566-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044728207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122944Medicaid
WA1122944Medicaid
WAI39680Medicare UPIN