MEDICARE: THE DOCTORS CLINIC A PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center		WA
2	261QM1300X	Multi-Specialty Clinic/Center		WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	50D1072026	OTHER	WA	CLIA

General Provider Information

NPI Number	:	1114124435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DOCTORS CLINIC A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	9621 RIDGETOP BLVD NW
Second Line	:
City	:	SILVERDALE
State	:	WA
Zip	:	98383-8502
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	945 HILDEBRAND LN NE
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2877
Country	:	US
Telephone Number	:	206-855-7700
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LINDA A. BROWN
Credential	:
Telephone Number	:	360-782-3600

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	11/24/2014

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Directions to “THE DOCTORS CLINIC A PROFESSIONAL CORPORATION ” Practice Location

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