Provider Demographics
NPI:1982149761
Name:THE POLYCLINIC
Entity Type:Organization
Organization Name:THE POLYCLINIC
Other - Org Name:THE POLYCLINIC MOHS SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-329-1760
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:SUITE 1090
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3586
Mailing Address - Country:US
Mailing Address - Phone:206-860-5595
Mailing Address - Fax:206-720-7447
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:SUITE 1090
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-860-5595
Practice Address - Fax:206-720-7447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical