Provider Demographics
NPI:1780934125
Name:IMMEDIATE CLINIC SEATTLE, INC
Entity type:Organization
Organization Name:IMMEDIATE CLINIC SEATTLE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CF)
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-734-7717
Mailing Address - Street 1:9000 HOLMAN RD NW
Mailing Address - Street 2:STE A-1
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117
Mailing Address - Country:US
Mailing Address - Phone:206-706-9001
Mailing Address - Fax:206-706-9002
Practice Address - Street 1:9000 HOLMAN RD NW
Practice Address - Street 2:STE A-1
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117
Practice Address - Country:US
Practice Address - Phone:206-706-9001
Practice Address - Fax:206-706-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care