Provider Demographics
NPI:1689866097
Name:PINEL CLINIC,PLLC
Entity Type:Organization
Organization Name:PINEL CLINIC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGMUIR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:800-831-3322
Mailing Address - Street 1:1800 COOPER POINT RD SW
Mailing Address - Street 2:BLDG 18
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1178
Mailing Address - Country:US
Mailing Address - Phone:360-491-8002
Mailing Address - Fax:
Practice Address - Street 1:1800 COOPER POINT RD SW
Practice Address - Street 2:BLDG 18
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1178
Practice Address - Country:US
Practice Address - Phone:360-491-8002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000186802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7129067Medicaid
WA7129067Medicaid