Healthcare Provider Details

I. General information

NPI: 1316140858
Provider Name (Legal Business Name): BRANCH MEDICAL CLINIC EVERETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 05/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W MARINE VIEW DR BLDG 2010
EVERETT WA
98207
US

IV. Provider business mailing address

1 BOONE RD CODE 08RAZD
BREMERTON WA
98312-1894
US

V. Phone/Fax

Practice location:
  • Phone: 425-304-4060
  • Fax: 425-304-4046
Mailing address:
  • Phone: 360-475-4160
  • Fax: 360-475-4676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM M CONDON
Title or Position: BUMED EBO MANAGER
Credential:
Phone: 240-401-3643