Provider Demographics
NPI:1235683194
Name:PUGET SOUND CHRISTIAN CLINIC
Entity Type:Organization
Organization Name:PUGET SOUND CHRISTIAN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-363-4105
Mailing Address - Street 1:2152 N 122ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8524
Mailing Address - Country:US
Mailing Address - Phone:206-363-4105
Mailing Address - Fax:206-363-1723
Practice Address - Street 1:19820 SCRIBER LAKE RD STE 2
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6121
Practice Address - Country:US
Practice Address - Phone:206-363-4106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty