Provider Demographics
NPI:1346620200
Name:THE POLYCLINIC PLLC
Entity Type:Organization
Organization Name:THE POLYCLINIC PLLC
Other - Org Name:THE POLYCLINIC SANDPOINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-860-5414
Mailing Address - Street 1:3216 NE 45TH PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4093
Mailing Address - Country:US
Mailing Address - Phone:206-525-4000
Mailing Address - Fax:
Practice Address - Street 1:3216 NE 45TH PL
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4093
Practice Address - Country:US
Practice Address - Phone:206-525-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE POLYCLINIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217115300Medicare PIN