Provider Demographics
NPI:1093969859
Name:MADRONA HILL URGENT CARE LLC
Entity Type:Organization
Organization Name:MADRONA HILL URGENT CARE LLC
Other - Org Name:MADRONA HILL PORT LUDLOW
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-344-3663
Mailing Address - Street 1:2500 W SIMS WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-2234
Mailing Address - Country:US
Mailing Address - Phone:360-344-3663
Mailing Address - Fax:360-344-3664
Practice Address - Street 1:9481 OAK BAY RD STE A
Practice Address - Street 2:
Practice Address - City:PORT LUDLOW
Practice Address - State:WA
Practice Address - Zip Code:98365-9794
Practice Address - Country:US
Practice Address - Phone:360-437-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MADRONA HILL URGENT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602565539261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care