Provider Demographics
NPI:1922037092
Name:ANCHOR MEDICAL CLINIC
Entity Type:Organization
Organization Name:ANCHOR MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:S
Authorized Official - Last Name:RENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-347-1666
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:8227 44TH AVE WEST SUITE E
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-0959
Mailing Address - Country:US
Mailing Address - Phone:425-347-1666
Mailing Address - Fax:425-355-5551
Practice Address - Street 1:8227 44TH AVE WEST
Practice Address - Street 2:SUITE E
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275
Practice Address - Country:US
Practice Address - Phone:425-347-1666
Practice Address - Fax:425-355-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD00019337OtherSTATE LICENSE
MD00019337OtherSTATE LICENSE