Provider Demographics
NPI:1285977983
Name:MARTHA AND MARY LUTHERAN SERVICES
Entity type:Organization
Organization Name:MARTHA AND MARY LUTHERAN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SOLVIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-779-7500
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-0127
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19160 FRONT STREET NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-0127
Practice Address - Country:US
Practice Address - Phone:360-779-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-01
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty