Basic Information
| Provider Information | |||||||||
| NPI: | 1902168461 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IMMEDIATE CLINIC SEATTLE, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | DOCTORS EXPRESS URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7332 E BUTHERUS DR | ||||||||
| Address2: | HANGAR ONE | ||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852602426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807347717 | ||||||||
| FaxNumber: | 4802476482 | ||||||||
| Practice Location | |||||||||
| Address1: | 607 SE EVERETT MALL WAY | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982083248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252657000 | ||||||||
| FaxNumber: | 4252657001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2012 | ||||||||
| LastUpdateDate: | 08/27/2012 | ||||||||
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| AuthorizedOfficialLastName: | DEAN | ||||||||
| AuthorizedOfficialFirstName: | GLENN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4807347717 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.