Provider Demographics
NPI:1801912241
Name:FIDALGO ISLAND WALK-IN CLINIC
Entity type:Organization
Organization Name:FIDALGO ISLAND WALK-IN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:360-299-2650
Mailing Address - Street 1:1500 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2235
Mailing Address - Country:US
Mailing Address - Phone:360-299-2650
Mailing Address - Fax:360-299-2651
Practice Address - Street 1:1500 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2235
Practice Address - Country:US
Practice Address - Phone:360-299-2650
Practice Address - Fax:360-299-2651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9648858Medicaid
WA9648858Medicaid
WAP00348651Medicare PIN
WA8859353Medicare PIN