Provider Demographics
NPI:1346267796
Name:OLYMPIA EMERGENCY SERVICES, PLLC
Entity Type:Organization
Organization Name:OLYMPIA EMERGENCY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-493-4554
Mailing Address - Street 1:PO BOX 84151
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5451
Mailing Address - Country:US
Mailing Address - Phone:360-493-4554
Mailing Address - Fax:
Practice Address - Street 1:413 LILLY RD NE
Practice Address - Street 2:MAILSTOP DDH09
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5133
Practice Address - Country:US
Practice Address - Phone:360-491-9480
Practice Address - Fax:360-493-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
50D0998652OtherCLAI
WA7109192Medicaid
WA8935574OtherWA CRIME VICITMS
OR268740Medicaid
WA0153352OtherWA L&I
533663001OtherGROUP HEALTH
CJ3476OtherRAILROAD MEDICARE
1659OLOtherPREMERA BC
192906100OtherUS DEPT OF LABOR
OR268740Medicaid