Basic Information
| Provider Information | |||||||||
| NPI: | 1548250012 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MINOR & JAMES MEDICAL PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 26947 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841260947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063869500 | ||||||||
| FaxNumber: | 2063869605 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 MINOR AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981042120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063869500 | ||||||||
| FaxNumber: | 2063869605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 12/01/2014 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | CMO | ||||||||
| AuthorizedOfficialTelephone: | 2063869500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 7136872 | 01 | WA | AUDIOLOGY MEDICAID | OTHER | 7139439 | 01 | WA | MEDICARE ASC/FHSC | OTHER | 144182 | 01 | L&I LABORATORY | OTHER | 7027352 | 01 | MEDICAID ASC | OTHER | 9060666 | 01 | WA | MEDICAID HEARING AIDS | OTHER | 501034 | 01 | MEDICARE/ASC CERT | OTHER | 5891740001 | 01 | WA | DME | OTHER | 7022544 | 05 | WA | MEDICAID | 215831 | 01 | WA | L&I ASC/FHSC | OTHER | 163569 | 01 | L&I ASC | OTHER | 8901651 | 01 | L&I CRIME VICTIMS | OTHER | 78900 | 01 | WA | LI | OTHER | CE1300 | 01 | PALMETTA GBA /RR MEDICARE | OTHER |