Provider Demographics
NPI:1659725455
Name:GUMSHOE HEALTH, P.S
Entity Type:Organization
Organization Name:GUMSHOE HEALTH, P.S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESMOND
Authorized Official - Suffix:
Authorized Official - Credentials:ND, LMP
Authorized Official - Phone:206-747-7681
Mailing Address - Street 1:101 E MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1519
Mailing Address - Country:US
Mailing Address - Phone:360-863-0642
Mailing Address - Fax:360-794-7236
Practice Address - Street 1:101 E MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1519
Practice Address - Country:US
Practice Address - Phone:360-863-0642
Practice Address - Fax:360-794-7236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60647845261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service