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General NPI Number Information
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NPI Number | 1700833357
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Entity Type | Organization
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Legal Business Name | THE DOCTORS CLINIC A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 11/01/2019
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Provider Practice Location Address
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Address Line | 2200 NW MYHRE RD
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City | SILVERDALE
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State | WA
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Zip | 98383-7681
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Country | US
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Telephone | 360-830-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 9621 RIDGETOP BLVD NW
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City | SILVERDALE
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State | WA
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Zip | 98383-8502
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JAY BURGHART
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Credential |
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Telephone | 360-782-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1200X
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Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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