Healthcare Provider Details

I. General information

NPI: 1386914562
Provider Name (Legal Business Name): WILLIAM C HOLLIDAY, MD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 130TH AVE NE SUITE A 211
BELLEVUE WA
98005-1755
US

IV. Provider business mailing address

2300 130TH AVE NE SUITE A 211
BELLEVUE WA
98005-1755
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-1110
  • Fax: 425-869-9578
Mailing address:
  • Phone: 425-869-1110
  • Fax: 425-869-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number00014845
License Number StateWA

VIII. Authorized Official

Name: DR. WILLIAM HOLLIDAY
Title or Position: OWNER
Credential: MD, PS
Phone: 425-869-1110