Provider Demographics
NPI:1710601299
Name:OLYMPIC VALLEY CLINIC, PLLC
Entity Type:Organization
Organization Name:OLYMPIC VALLEY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-485-0046
Mailing Address - Street 1:1905 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-9761
Mailing Address - Country:US
Mailing Address - Phone:360-451-8719
Mailing Address - Fax:
Practice Address - Street 1:11 SCHOUWEILER RD
Practice Address - Street 2:
Practice Address - City:ELMA
Practice Address - State:WA
Practice Address - Zip Code:98541-9306
Practice Address - Country:US
Practice Address - Phone:360-482-5300
Practice Address - Fax:360-482-5900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care