Healthcare Provider Details

I. General information

NPI: 1841670619
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

3400 CALIFORNIA AVE SW SUITE 200
SEATTLE WA
98116-3307
US

IV. Provider business mailing address

1145 BROADWAY
SEATTLE WA
98122-4201
US

V. Phone/Fax

Practice location:
  • Phone: 206-860-5575
  • 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 Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

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