Provider Demographics
NPI:1790061158
Name:PRIMARY CARE OF SEATTLE, PLLC
Entity Type:Organization
Organization Name:PRIMARY CARE OF SEATTLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JERI
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-368-1311
Mailing Address - Street 1:1530 N 115TH ST.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8417
Mailing Address - Country:US
Mailing Address - Phone:206-368-1311
Mailing Address - Fax:206-366-0907
Practice Address - Street 1:1530 N 115TH ST.
Practice Address - Street 2:SUITE 104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8417
Practice Address - Country:US
Practice Address - Phone:206-368-1311
Practice Address - Fax:206-366-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60099255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty