Provider Demographics
NPI:1639255698
Name:US COAST GUARD
Entity Type:Organization
Organization Name:US COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CLINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ADMINISTRATOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-217-6441
Mailing Address - Street 1:ISC SEATTLE
Mailing Address - Street 2:1519 ALASKAN WAY SOUTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-1102
Mailing Address - Country:US
Mailing Address - Phone:206-217-6441
Mailing Address - Fax:206-217-6636
Practice Address - Street 1:1519 ALASKAN WAY S
Practice Address - Street 2:ISC SEATTLE/MEDICAL
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1102
Practice Address - Country:US
Practice Address - Phone:206-217-6441
Practice Address - Fax:206-217-6636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient