Provider Demographics
NPI:1952453748
Name:OLYMPIA ARTHRITIS & REHABILITATION CLINIC INC PS
Entity Type:Organization
Organization Name:OLYMPIA ARTHRITIS & REHABILITATION CLINIC INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-754-6700
Mailing Address - Street 1:1212 HARRISON AVE NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5466
Mailing Address - Country:US
Mailing Address - Phone:360-754-6700
Mailing Address - Fax:360-754-0164
Practice Address - Street 1:1212 HARRISON AVE NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5466
Practice Address - Country:US
Practice Address - Phone:360-754-6700
Practice Address - Fax:360-357-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024518173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8235038Medicaid
WA126185OtherL&I NUMBER YSC
WA1027689Medicaid
WA12371OtherL&I NUMBER MWL
WA1027689Medicaid
WA126185OtherL&I NUMBER YSC
WAAB06601Medicare ID - Type UnspecifiedMEDICARE NUMBER YSC
WA8235038Medicaid
WA001046802Medicare ID - Type UnspecifiedMEDICARE NUMBER MWL