Provider Demographics
NPI:1043586332
Name:INTEGRATED MEDICAL CLINICS, PLLC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL CLINICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:WALING
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:425-417-8147
Mailing Address - Street 1:200 W. MERCER STREET, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119
Mailing Address - Country:US
Mailing Address - Phone:206-281-7827
Mailing Address - Fax:206-281-5333
Practice Address - Street 1:200 W MERCER ST STE 101
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3958
Practice Address - Country:US
Practice Address - Phone:206-281-7827
Practice Address - Fax:206-281-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP 00000701207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8858832Medicare PIN