Provider Demographics
NPI:1124149851
Name:AMEN CLINICS INC, BELLEVUE
Entity type:Organization
Organization Name:AMEN CLINICS INC, BELLEVUE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DATA SYSTEMS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:703-880-4000
Mailing Address - Street 1:545 ANDOVER PARK W STE 101
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-3347
Mailing Address - Country:US
Mailing Address - Phone:425-455-7500
Mailing Address - Fax:253-779-8969
Practice Address - Street 1:545 ANDOVER PARK W STE 101
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3347
Practice Address - Country:US
Practice Address - Phone:425-455-7500
Practice Address - Fax:425-454-7845
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMEN CLINICS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-02
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084D0003XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyDiagnostic NeuroimagingGroup - Multi-Specialty