Provider Demographics
NPI:1245398858
Name:ALLENMORE CHILDREN & YOUNG ADULT CLINIC
Entity Type:Organization
Organization Name:ALLENMORE CHILDREN & YOUNG ADULT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHNELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-627-9145
Mailing Address - Street 1:1924 S CEDAR ST
Mailing Address - Street 2:A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-627-9145
Mailing Address - Fax:253-383-1556
Practice Address - Street 1:1924 S CEDAR ST
Practice Address - Street 2:A
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-627-9145
Practice Address - Fax:253-383-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7041478Medicaid