| |
4200 Aurora Ave N Seattle WA 98103-7308 | |
(206) 620-0611 | |
(206) 620-0622 |
Full Name | |
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Speciality | Clinic/Center |
Location | 4200 Aurora Ave N, Seattle, Washington |
Authorized Official Name and Position | Clinton Lee Bliss (DOCTOR OWNER) |
Authorized Official Contact | 2066200611 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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4200 Aurora Ave N Seattle WA 98103-7308 Ph: (206) 620-0611 | 4200 Aurora Ave N Seattle WA 98103-7308 Ph: (206) 620-0611 |
NPI Number | 1164826905 |
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Provider Enumeration Date | 10/21/2014 |
Last Update Date | 06/19/2019 |
Medicare PECOS PAC ID | 9234465329 |
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Medicare Enrollment ID | O20190726002395 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164826905 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Clinton L Bliss |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1033228655 PECOS PAC ID: 2062692890 Enrollment ID: I20110210000451 |
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