Healthcare Provider Details

I. General information

NPI: 1740660513
Provider Name (Legal Business Name): THE POLYCLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

11545 15TH AVE NE SUITE 205
SEATTLE WA
98125-6358
US

IV. Provider business mailing address

1145 BROADWAY
SEATTLE WA
98122-4201
US

V. Phone/Fax

Practice location:
  • Phone: 206-364-2010
  • Fax:
Mailing address:
  • Phone: 206-329-1760
  • 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 Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LLOYD DAVID
Title or Position: CEO
Credential:
Phone: 206-860-4401