Healthcare Provider Details

I. General information

NPI: 1346620200
Provider Name (Legal Business Name): THE POLYCLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NE 45TH PL SUITE 200
SEATTLE WA
98105-4093
US

IV. Provider business mailing address

3216 NE 45TH PL SUITE 200
SEATTLE WA
98105-4093
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-4000
  • Fax:
Mailing address:
  • Phone: 206-525-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CRAIG PEPIN
Title or Position: PHYSICIAN/OWNER
Credential:
Phone: 206-860-5414