Healthcare Provider Details

I. General information

NPI: 1154201002
Provider Name (Legal Business Name): SAMUEL HOLT MCCREA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MADISON ST STE 1220
SEATTLE WA
98104-1356
US

IV. Provider business mailing address

1221 MADISON ST STE 1220
SEATTLE WA
98104-1356
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-4250
  • Fax: 206-215-4252
Mailing address:
  • Phone: 206-215-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1252633
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: