Provider Demographics
NPI:1003962408
Name:FREELAND CLINIC INC
Entity Type:Organization
Organization Name:FREELAND CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHSYICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:JULIANNE
Authorized Official - Last Name:ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-331-5115
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:WA
Mailing Address - Zip Code:98249-0279
Mailing Address - Country:US
Mailing Address - Phone:360-331-5115
Mailing Address - Fax:360-331-7505
Practice Address - Street 1:1660 E LAYTON STREET
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:WA
Practice Address - Zip Code:98249-0279
Practice Address - Country:US
Practice Address - Phone:360-331-5115
Practice Address - Fax:360-331-7505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD0013247261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care