Healthcare Provider Details

I. General information

NPI: 1073663480
Provider Name (Legal Business Name): DOCTORS CLINIC A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NW MYHRE RD
SILVERDALE WA
98383-7681
US

IV. Provider business mailing address

9621 RIDGETOP BLVD NW
SILVERDALE WA
98383-8502
US

V. Phone/Fax

Practice location:
  • Phone: 360-830-1100
  • Fax: 360-830-1283
Mailing address:
  • Phone: 360-782-3650
  • Fax: 360-782-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAY BURGHART
Title or Position: CEO
Credential:
Phone: 360-782-3650