MEDICARE: PREEMPTIVE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1619859329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREEMPTIVE CLINIC

Provider Business Mailing Address
First Line	:	1522 WESTERN AVE STE 24105
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-1522
Country	:	US
Telephone Number	:	352-788-2993
Fax Number	:	352-386-3576

Provider Business Practice Location Address
First Line	:	5283 HAWKESBURY WAY
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-9582
Country	:	US
Telephone Number	:	352-788-2993
Fax Number	:	352-386-3576

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JAMIEN MCCULLUM
Credential	:
Telephone Number	:	650-814-4524

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	01/28/2026

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Directions to “PREEMPTIVE CLINIC ” Practice Location

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