Healthcare Provider Details

I. General information

NPI: 1356210892
Provider Name (Legal Business Name): OLYMPIC PENINSULA COMMUNITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 GEORGIANA ST
PORT ANGELES WA
98362-3511
US

IV. Provider business mailing address

819 GEORGIANA ST
PORT ANGELES WA
98362-3511
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-4431
  • Fax: 360-457-7755
Mailing address:
  • Phone: 360-457-4431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: T SCOTT BRANDON
Title or Position: CEO
Credential:
Phone: 360-457-4431