Healthcare Provider Details

I. General information

NPI: 1477713196
Provider Name (Legal Business Name): RAINIER OCCUPATIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SOUTH JACKSON ST #24
SEATTLE WA
98144-2096
US

IV. Provider business mailing address

1400 SOUTH JACKSON ST #24
SEATTLE WA
98144-2096
US

V. Phone/Fax

Practice location:
  • Phone: 206-568-8577
  • Fax: 206-568-3385
Mailing address:
  • Phone: 206-568-8577
  • Fax: 206-568-3385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number19706
License Number StateWA

VIII. Authorized Official

Name: MISS DEBORAH LYNN MOORE
Title or Position: OFFICE MANAGER
Credential:
Phone: 206-568-8577