Provider Demographics
NPI: | 1720140619 |
---|---|
Name: | ALLCARE MEDICAL CLINIC INC. |
Entity type: | Organization |
Organization Name: | ALLCARE MEDICAL CLINIC INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DHIREN |
Authorized Official - Middle Name: | N |
Authorized Official - Last Name: | AJUDIA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 425-255-0055 |
Mailing Address - Street 1: | 148 PARK AVE N |
Mailing Address - Street 2: | |
Mailing Address - City: | RENTON |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98057-5719 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 425-255-0055 |
Mailing Address - Fax: | 425-255-9501 |
Practice Address - Street 1: | 148 PARK AVE N |
Practice Address - Street 2: | |
Practice Address - City: | RENTON |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98057-5719 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-255-0055 |
Practice Address - Fax: | 425-255-9501 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-12-15 |
Last Update Date: | 2008-09-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | 208D00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Single Specialty |