104Th Avenue Medical Clinic Incorporated in Kent - Clinic/center
104Th Avenue Medical Clinic Incorporated - NPI 1396921326
104Th Avenue Medical Clinic Incorporated is a Clinic/center in Kent, Washington. 104Th Avenue Medical Clinic Incorporated practices all healthcare services and medical treatments related to Clinic/center. The NPI Number for 104Th Avenue Medical Clinic Incorporated is 1396921326. The last update date is 2014-10-01.
104Th Avenue Medical Clinic Incorporated's current location address is 24604 104th Ave Se, Kent, Washington. You can contact this provider via phone number 2538598371. The mailing address for 104Th Avenue Medical Clinic Incorporated is 24604 104th Ave Se, Kent, Washington. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | 104Th Avenue Medical Clinic Incorporated |
|---|---|
| Address | 24604 104th Ave Se, Kent, Washington |
| Phone Number | 2538598371 |
| Fax Number | |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | VICE-PRESI |
|---|---|
| Authorized Official Name | Choudhary Ranu |
| Credentials | M.D. |
| Telephone Number | 2538598371 |
NPI Number Detail
| NPI Number | 1396921326 |
|---|---|
| Provider Enumeration Date | 2008-01-22 |
| Last Updated Date | 2014-10-01 |
Provider Mailing Address Detail
| Address | 24604 104th Ave Se |
|---|---|
| City | Kent |
| State | Washington (WA) |
| Post Code | 980305385 |
| Phone Number | 2538598371 |
| Fax Number |
Provider's Primary Taxonomy Detail
| Speciality | Clinic/center |
|---|---|
| Taxonomy | 261Q00000X |
| Licence No | 37861 |
|
Definition: A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 1110378 | WA | -- |
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What is the unique identifier code issued to 104Th Avenue Medical Clinic Incorporated by the Centers for Medicare & Medicaid Services?
The 104Th Avenue Medical Clinic Incorporated has been assigned the NPI (National Provider Identifier) 1396921326. This 10-digit code serves as a unique identification number for healthcare providers issued by the Centers for Medicare & Medicaid Services (CMS).
Where is the 104Th Avenue Medical Clinic Incorporated located?
The 104Th Avenue Medical Clinic Incorporated is located at 24604 104Th Ave Se, Kent, WA 980305385.
What is the 104Th Avenue Medical Clinic Incorporated's specialty and taxonomy code?
The 104Th Avenue Medical Clinic Incorporated's specialty is Clinic/center, and the corresponding taxonomy code is 261Q00000X.
When was the 104Th Avenue Medical Clinic Incorporated's 1396921326 issued?
The 104Th Avenue Medical Clinic Incorporated's 1396921326 was issued on 2008-01-22.
When was the information regarding 104Th Avenue Medical Clinic Incorporated most recently updated?
The details pertaining to the 104Th Avenue Medical Clinic Incorporated, including its address, specialty, and other relevant information, were last refreshed on 2014-10-01.
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