Provider Demographics
NPI:1215446729
Name:MEDTRIQ TREATMENT CENTER LLC
Entity type:Organization
Organization Name:MEDTRIQ TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AJAINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERGILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-334-1882
Mailing Address - Street 1:1567 HIGHLANDS DR NE STE 110-345
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-6245
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2603 BRIDGEPORT WAY W STE F
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4724
Practice Address - Country:US
Practice Address - Phone:253-666-6780
Practice Address - Fax:253-666-6793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-27
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604172507261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center