Provider Demographics
NPI:1740823566
Name:NORTH STAR CLINIC LLC
Entity type:Organization
Organization Name:NORTH STAR CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:III
Authorized Official - Credentials:PA-C
Authorized Official - Phone:360-531-3989
Mailing Address - Street 1:PO BOX 315
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-0315
Mailing Address - Country:US
Mailing Address - Phone:360-531-3989
Mailing Address - Fax:
Practice Address - Street 1:2120 LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-7925
Practice Address - Country:US
Practice Address - Phone:360-531-3989
Practice Address - Fax:360-344-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-24
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care