Healthcare Provider Details

I. General information

NPI: 1780934125
Provider Name (Legal Business Name): IMMEDIATE CLINIC SEATTLE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 HOLMAN RD NW STE A-1
SEATTLE WA
98117
US

IV. Provider business mailing address

9000 HOLMAN RD NW STE A-1
SEATTLE WA
98117
US

V. Phone/Fax

Practice location:
  • Phone: 206-706-9001
  • Fax: 206-706-9002
Mailing address:
  • Phone: 206-706-9001
  • Fax: 206-706-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GLENN DEAN
Title or Position: CF)
Credential:
Phone: 480-734-7717