Provider Demographics
NPI:1417064643
Name:OLYMPIC CLINICAL SERVICES, INC.
Entity Type:Organization
Organization Name:OLYMPIC CLINICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DOWNS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-275-7629
Mailing Address - Street 1:18820 AURORA AVE N
Mailing Address - Street 2:SUITE 104B
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3900
Mailing Address - Country:US
Mailing Address - Phone:206-542-7118
Mailing Address - Fax:206-542-7338
Practice Address - Street 1:1550 N 115TH ST
Practice Address - Street 2:MAILSTOP E170
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8401
Practice Address - Country:US
Practice Address - Phone:206-368-1244
Practice Address - Fax:206-368-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30001778363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9635806Medicaid
WA0142812OtherLABOR AND INDUSTRIES
WAS35384Medicare UPIN
WAGAB36279Medicare PIN
WA0142812OtherLABOR AND INDUSTRIES