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3216 Ne 45th Pl Ste 301 Seattle WA 98105-4028 | |
(206) 339-3360 | |
(206) 212-1100 |
Full Name | |
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Speciality | Clinic/Center |
Location | 3216 Ne 45th Pl Ste 301, Seattle, Washington |
Authorized Official Name and Position | Audrey Young (OWNER) |
Authorized Official Contact | 2063393360 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3216 Ne 45th Pl Ste 301 Seattle WA 98105-4028 Ph: (206) 339-3360 | 3216 Ne 45th Pl Ste 301 Seattle WA 98105-4028 Ph: (206) 339-3360 |
NPI Number | 1174367395 |
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Provider Enumeration Date | 06/21/2024 |
Last Update Date | 08/16/2024 |
Medicare PECOS PAC ID | 3678011004 |
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Medicare Enrollment ID | O20240816002185 |
Identifier | Type | State | Issuer |
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1174367395 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Audrey J Young Crissman |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1982761110 PECOS PAC ID: 9739153867 Enrollment ID: I20040824000533 |
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