Provider Demographics
NPI:1306012083
Name:OLYMPIA PEDIATRICS, PLLC
Entity Type:Organization
Organization Name:OLYMPIA PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-413-8364
Mailing Address - Street 1:525 LILLY RD NE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5101
Mailing Address - Country:US
Mailing Address - Phone:360-413-8470
Mailing Address - Fax:360-413-8491
Practice Address - Street 1:525 LILLY RD NE
Practice Address - Street 2:SUITE 250
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5101
Practice Address - Country:US
Practice Address - Phone:360-413-8470
Practice Address - Fax:360-413-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty