Provider Demographics
NPI:1164642278
Name:COUNTRY DOCTOR COMMUNITY CLINIC
Entity Type:Organization
Organization Name:COUNTRY DOCTOR COMMUNITY CLINIC
Other - Org Name:CAROLYN DOWNS FAMILLY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCVEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-299-1628
Mailing Address - Street 1:2101 E YESLER WAY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5959
Mailing Address - Country:US
Mailing Address - Phone:206-299-1984
Mailing Address - Fax:206-299-1920
Practice Address - Street 1:2101 E YESLER WAY
Practice Address - Street 2:SUITE 150
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5959
Practice Address - Country:US
Practice Address - Phone:206-299-1984
Practice Address - Fax:206-299-1920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0016943OtherLABOR & INDUSTRIES
WA7056617Medicaid
WA7402852Medicaid
WA7900632Medicaid
WA7900632Medicaid
WA7402852Medicaid