Healthcare Provider Details

I. General information

NPI: 1659609642
Provider Name (Legal Business Name): SULLIVAN PULMONARY CLINIC TR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 N 115TH ST SUITE 107
SEATTLE WA
98133-8421
US

IV. Provider business mailing address

1530 N 115TH ST SUITE 107
SEATTLE WA
98133-8421
US

V. Phone/Fax

Practice location:
  • Phone: 206-368-6160
  • Fax:
Mailing address:
  • Phone: 206-368-6160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM CHARLES SCHNEIDER
Title or Position: CEO
Credential:
Phone: 206-368-1700