Provider Demographics
NPI:1649484833
Name:OLYMPIC PHYSICIANS P.L.L.C.
Entity type:Organization
Organization Name:OLYMPIC PHYSICIANS P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLAUDERAFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-426-2500
Mailing Address - Street 1:237 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584
Mailing Address - Country:US
Mailing Address - Phone:360-426-2500
Mailing Address - Fax:360-426-2787
Practice Address - Street 1:237 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584
Practice Address - Country:US
Practice Address - Phone:360-426-2500
Practice Address - Fax:360-426-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042875207R00000X
WAOP00001739207R00000X
WAMD00045960207Q00000X
WAPA10004942363A00000X
WAMD00047153207R00000X
WAMD00019248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7090947Medicaid
WA7090947Medicaid