Healthcare Provider Details

I. General information

NPI: 1124149851
Provider Name (Legal Business Name): AMEN CLINICS INC, BELLEVUE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 01/19/2022
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ANDOVER PARK W STE 101
TUKWILA WA
98188-3347
US

IV. Provider business mailing address

545 ANDOVER PARK W STE 101
TUKWILA WA
98188-3347
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-7500
  • Fax: 425-454-7845
Mailing address:
  • Phone: 425-455-7500
  • Fax: 253-779-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084D0003X
TaxonomyDiagnostic Neuroimaging (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA T MCCORMICK
Title or Position: DATA SYSTEMS SPECIALIST
Credential: MS
Phone: 703-880-4000