MEDICARE: MITCHELL INTERNATIONAL, INC.

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	305R00000X	Preferred Provider Organization

General Provider Information

NPI Number	:	1225529407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL INTERNATIONAL, INC.

Provider Business Mailing Address
First Line	:	6220 GREENWICH DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5913
Country	:	US
Telephone Number	:	858-368-7000
Fax Number	:	858-547-5470

Provider Business Practice Location Address
First Line	:	1301 5TH AVE STE 2900
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-2644
Country	:	US
Telephone Number	:	206-343-6100
Fax Number	:	206-812-6405

Authorized Official
Title or Position	:	EVP, GENERAL MANAGER
Name	:	NINA SMITH
Credential	:
Telephone Number	:	949-335-1500

Provider Enumeration Date	:	05/23/2018
Last Update Date	:	05/23/2018

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