Provider Demographics
NPI:1568860849
Name:PUGET SOUND CHRISTIAN CLINIC
Entity Type:Organization
Organization Name:PUGET SOUND CHRISTIAN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CREELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-354-9533
Mailing Address - Street 1:2150 N 122ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8524
Mailing Address - Country:US
Mailing Address - Phone:206-363-4105
Mailing Address - Fax:206-363-1723
Practice Address - Street 1:2150 N 122ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8524
Practice Address - Country:US
Practice Address - Phone:206-363-4105
Practice Address - Fax:206-363-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty