Provider Demographics
NPI:1508182692
Name:QLIANCE MEDICAL GROUP OF WA
Entity Type:Organization
Organization Name:QLIANCE MEDICAL GROUP OF WA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRISON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-381-3030
Mailing Address - Street 1:999 3RD AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-4019
Mailing Address - Country:US
Mailing Address - Phone:206-381-3030
Mailing Address - Fax:206-381-3035
Practice Address - Street 1:521 2ND PL N
Practice Address - Street 2:SUITE 103
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-4537
Practice Address - Country:US
Practice Address - Phone:253-478-4900
Practice Address - Fax:253-478-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty