Provider Demographics
NPI:1821101197
Name:OLYMPIA MULTI-SPECIALTY CLINIC AMBULATORY PROCEDURES CNTR PLLC
Entity Type:Organization
Organization Name:OLYMPIA MULTI-SPECIALTY CLINIC AMBULATORY PROCEDURES CNTR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:360-704-3401
Mailing Address - Street 1:406 BLACK HILLS LN SW STE A
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8144
Mailing Address - Country:US
Mailing Address - Phone:360-704-3401
Mailing Address - Fax:360-754-1783
Practice Address - Street 1:3920 CAPITOL MALL DR SW
Practice Address - Street 2:SUITE 300
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8700
Practice Address - Country:US
Practice Address - Phone:360-704-3401
Practice Address - Fax:360-754-0298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00057092174400000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty