Provider Demographics
NPI:1073079034
Name:BLISS MEDICAL CENTER
Entity Type:Organization
Organization Name:BLISS MEDICAL CENTER
Other - Org Name:BLISS MEDICAL PROFESSIONALS PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-963-9646
Mailing Address - Street 1:4200 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7308
Mailing Address - Country:US
Mailing Address - Phone:206-629-0611
Mailing Address - Fax:206-620-0622
Practice Address - Street 1:4200 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7308
Practice Address - Country:US
Practice Address - Phone:206-629-0611
Practice Address - Fax:206-620-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty