Provider Demographics
NPI:1457740359
Name:SALISH INTEGRATIVE MEDICINE, INC
Entity Type:Organization
Organization Name:SALISH INTEGRATIVE MEDICINE, INC
Other - Org Name:SALISH INTEGRATIVE CANCER CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STANLEE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-382-6300
Mailing Address - Street 1:3700 PACIFIC HWY E STE 100
Mailing Address - Street 2:
Mailing Address - City:FIFE
Mailing Address - State:WA
Mailing Address - Zip Code:98424-1160
Mailing Address - Country:US
Mailing Address - Phone:253-382-6300
Mailing Address - Fax:253-382-6301
Practice Address - Street 1:3700 PACIFIC HWY E STE 100
Practice Address - Street 2:
Practice Address - City:FIFE
Practice Address - State:WA
Practice Address - Zip Code:98424-1160
Practice Address - Country:US
Practice Address - Phone:253-382-6300
Practice Address - Fax:253-382-6301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No163WI0500XNursing Service ProvidersRegistered NurseInfusion TherapyGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No1835X0200XPharmacy Service ProvidersPharmacistOncologyGroup - Multi-Specialty
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No364SX0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistOncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026972Medicaid
WA11509443OtherCAQH
WA12546547OtherCAQH
WA49566OtherPEN
WA13870286OtherCAQH
WA9643818Medicaid
WA9643818Medicaid