Provider Demographics
NPI:1356309330
Name:DOCTORS CLINIC APC
Entity Type:Organization
Organization Name:DOCTORS CLINIC APC
Other - Org Name:THE DOCTORS CLINIC OF EAST BREMERTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-782-3600
Mailing Address - Street 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2512 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3399
Practice Address - Country:US
Practice Address - Phone:360-782-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261Q00000X, 261QM1300X
261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8914602OtherCVCP
50D0911681OtherCLIA
WA75420OtherLABOR & INDUSTRIES
WA8914602OtherCRIME VICTIMS COMP
WA7041312Medicaid
WACU0247OtherRAILROAD MEDICARE
20337OtherCOAL MINE WORKERS COMP
337018601OtherOWCP
WA8914602OtherCRIME VICTIMS COMP
WAG000250400Medicare PIN