Provider Demographics
NPI:1578871224
Name:UMA CLINIC
Entity Type:Organization
Organization Name:UMA CLINIC
Other - Org Name:ERICA L EICKHOFF, LMP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LEILANI
Authorized Official - Last Name:EICKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LMP
Authorized Official - Phone:206-293-4927
Mailing Address - Street 1:4425 FREMONT AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-7225
Mailing Address - Country:US
Mailing Address - Phone:206-293-4927
Mailing Address - Fax:
Practice Address - Street 1:4425 FREMONT AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-7225
Practice Address - Country:US
Practice Address - Phone:206-293-4927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00007811174400000X
WAMA 00021407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty