=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255312690
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MINOR & JAMES MEDICAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 MINOR AVE #100
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98104-2120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-386-9500
-----------------------------------------------------
Fax | 206-386-9605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3489
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98114-3489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-386-9500
-----------------------------------------------------
Fax | 206-386-9605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PETER MOHAI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 206-386-9500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------