Healthcare Provider Details

I. General information

NPI: 1982149761
Provider Name (Legal Business Name): THE POLYCLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 MADISON ST SUITE 1090
SEATTLE WA
98104-3586
US

IV. Provider business mailing address

1229 MADISON ST SUITE 1090
SEATTLE WA
98104-3586
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-5595
  • Fax: 206-720-7447
Mailing address:
  • Phone: 206-860-5595
  • Fax: 206-720-7447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LLOYD DAVID
Title or Position: CEO
Credential:
Phone: 206-329-1760