Provider Demographics
NPI:1417156183
Name:OLYMPIC PHYSICIANS P.L.L.C.
Entity Type:Organization
Organization Name:OLYMPIC PHYSICIANS P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLAUDERAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-426-2500
Mailing Address - Street 1:237 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-4404
Mailing Address - Country:US
Mailing Address - Phone:360-426-2500
Mailing Address - Fax:360-426-2787
Practice Address - Street 1:221 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-4404
Practice Address - Country:US
Practice Address - Phone:360-426-2500
Practice Address - Fax:360-426-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7140098Medicaid
WAGAB05318Medicare PIN