Provider Demographics
NPI:1417085614
Name:USCG ISC SEATTLE
Entity Type:Organization
Organization Name:USCG ISC SEATTLE
Other - Org Name:COAST GUARD
Other - Org Type:Other Name
Authorized Official - Title/Position:HS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:SR
Authorized Official - Credentials:HEALTH SERVICE
Authorized Official - Phone:206-546-3076
Mailing Address - Street 1:1519 ALASKAN WAY SOUTH
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134
Mailing Address - Country:US
Mailing Address - Phone:206-217-6563
Mailing Address - Fax:
Practice Address - Street 1:1519 ALASKAN WAY SOUTH
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134
Practice Address - Country:US
Practice Address - Phone:206-217-6563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center