Healthcare Provider Details

I. General information

NPI: 1013061217
Provider Name (Legal Business Name): PACMED CLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date: 07/17/2007
Reactivation Date: 02/29/2008

III. Provider practice location address

1200 12TH AVE S
SEATTLE WA
98124
US

IV. Provider business mailing address

PO BOX 24386 PACMED CLINICS
SEATTLE WA
98124-0386
US

V. Phone/Fax

Practice location:
  • Phone: 206-621-4316
  • Fax:
Mailing address:
  • Phone: 206-621-4316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONALD WAYNE ANDERSON JR.
Title or Position: ASSISTANT SECREATRY FOR ENROLLMENT
Credential:
Phone: 425-358-9786