Basic Information
| Provider Information | |||||||||
| NPI: | 1144451923 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OLYMPIC PHYSICIANS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 PROFESSIONAL WAY | ||||||||
| Address2: | |||||||||
| City: | SHELTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985844404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604262500 | ||||||||
| FaxNumber: | 3604622500 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 PROFESSIONAL WAY | ||||||||
| Address2: | |||||||||
| City: | SHELTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985844404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604262500 | ||||||||
| FaxNumber: | 3604622500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 07/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | SCHLAUDERAFF | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINIC MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3604262500 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | RN, BSN, MSM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.