Provider Demographics
NPI:1497703839
Name:THE DOCTORS CLINIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:THE DOCTORS CLINIC A PROFESSIONAL CORPORATION
Other - Org Name:THE DOCTORS CLINIC WOMEN'S & CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
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 1:1780 NW MYHRE RD
Practice Address - Street 2:SUITE 2120
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-782-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
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
50D0860394OtherCLIA
WA7102080Medicaid
337018606OtherOWCP
WA75420OtherLABOR & INDUSTRIES
CU0247OtherRAILROAD MEDICARE
WA75420OtherLABOR & INDUSTRIES
WA7102080Medicaid