Provider Demographics
NPI:1922038645
Name:PORT TOWNSEND WOMENS CLINIC PLLC
Entity Type:Organization
Organization Name:PORT TOWNSEND WOMENS CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:HARDING
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:360-344-3700
Mailing Address - Street 1:PO BOX 1560
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0052
Mailing Address - Country:US
Mailing Address - Phone:360-344-3700
Mailing Address - Fax:360-344-3707
Practice Address - Street 1:1136 WATER ST
Practice Address - Street 2:SUITE 105
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6728
Practice Address - Country:US
Practice Address - Phone:360-344-3700
Practice Address - Fax:360-344-3707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6024192145207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7125446Medicaid
WA7125446Medicaid