| |
4744 41st Ave Sw Ste 102 Seattle WA 98116-4566 | |
(206) 932-0880 | |
(206) 932-3738 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 4744 41st Ave Sw Ste 102, Seattle, Washington |
Authorized Official Name and Position | Martin Paul Ross (PRESIDENT) |
Authorized Official Contact | 2069320880 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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4744 41st Ave Sw Ste 102 Seattle WA 98116-4566 Ph: (206) 932-0880 | 4744 41st Ave Sw Ste 102 Seattle WA 98116-4566 Ph: (206) 932-0880 |
NPI Number | 1316099724 |
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Provider Enumeration Date | 01/17/2007 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1316099724 | NPI | - | NPPES |
MD33296 | Other | WA | BUSINESS LICENSE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | MD3329 (Washington) | Primary |
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