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General NPI Number Information
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NPI Number | 1043586332
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Entity Type | Organization
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Legal Business Name | INTEGRATED MEDICAL CLINICS, PLLC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 200 W MERCER ST STE 101
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City | SEATTLE
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State | WA
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Zip | 98119-3958
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Country | US
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Telephone | 206-281-7827
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Fax | 206-281-5333
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Provider Business Mailing Address
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Address Line | 200 W. MERCER STREET, SUITE 101
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City | SEATTLE
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State | WA
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Zip | 98119
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Country | US
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Telephone | 206-281-7827
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Fax | 206-281-5333
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD GERARD WALING
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Credential | ND
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Telephone | 425-417-8147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OP 00000701
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License Number State | WA
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