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
1	261QP2300X	Primary Care Clinic/Center
2	261Q00000X	Clinic/Center
3	261QM1300X	Multi-Specialty Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CU0247	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	337018600	OTHER	WA	OWCP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	50D0635293	OTHER	WA	CLIA
5	8919256	OTHER	WA	CRIME VICTIMS COMPENSATIO

General Provider Information

NPI Number	:	1396793709
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	:	450 S KITSAP BLVD
Second Line	:	BLDG. 1, SUITE 250
City	:	PORT ORCHARD
State	:	WA
Zip	:	98366-3773
Country	:	US
Telephone Number	:	360-782-3000
Fax Number	:	360-782-3040

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JAY BURGHART
Credential	:
Telephone Number	:	360-782-3600

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	11/01/2019

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Practice Location Address:

450 S KITSAP BLVD
PORT ORCHARD, WA
98366-3773

Practice Phone: 360-874-5900
Practice Fax:

1922099696 — MRS. MELISSA R OTTENBACHER ARNP
Practice Location Address:

450 S KITSAP BLVD , STE 2300
PORT ORCHARD, WA
98366-3773

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1629057658 — DR. CHRISTOPHER S QUARLES MD
Practice Location Address:

450 S KITSAP BLVD
PORT ORCHARD, WA
98366-3773

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Practice Fax: 253-944-2099

1376592162 — JAMES RICHARD BATES M.D.
Practice Location Address:

450 S KITSAP BLVD , BLDG. 1, SUITE 250
PORT ORCHARD, WA
98366-3773

Practice Phone: 360-782-3000
Practice Fax: 360-782-3040

1255380804 — DR. HECTOR DECENA REYES JR. MD
Practice Location Address:

450 S KITSAP BLVD
PORT ORCHARD, WA
98366-3773

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1386694099 — OLYMPIC PENINSULA KIDNEY CENTER
Practice Location Address:

450 S KITSAP BLVD , SUITE 178
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Directions to “THE DOCTORS CLINIC A PROFESSIONAL CORPORATION ” Practice Location

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