Provider Demographics
NPI:1013061217
Name:PACMED CLINICS
Entity type:Organization
Organization Name:PACMED CLINICS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECREATRY FOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-358-9786
Mailing Address - Street 1:PO BOX 24386
Mailing Address - Street 2:PACMED CLINICS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0386
Mailing Address - Country:US
Mailing Address - Phone:206-621-4316
Mailing Address - Fax:
Practice Address - Street 1:1200 12TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98124
Practice Address - Country:US
Practice Address - Phone:206-621-4316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2025-05-08
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2008-02-29
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB34789Medicare ID - Type Unspecified
WAAB34788Medicare ID - Type Unspecified
WAAB36366Medicare ID - Type Unspecified