Provider Demographics
NPI:1245630979
Name:EASTHILL MEDICAL CLINIC LLC
Entity type:Organization
Organization Name:EASTHILL MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EFREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARATAO, JR.
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:253-852-2770
Mailing Address - Street 1:10413 SE 244TH ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4961
Mailing Address - Country:US
Mailing Address - Phone:253-852-2770
Mailing Address - Fax:
Practice Address - Street 1:10413 SE 244TH ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4961
Practice Address - Country:US
Practice Address - Phone:253-852-2770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00028063261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA208D00000XMedicaid
WA21700714Medicare UPIN