Provider Demographics
NPI:1902168461
Name:IMMEDIATE CLINIC SEATTLE, INC
Entity type:Organization
Organization Name:IMMEDIATE CLINIC SEATTLE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-734-7717
Mailing Address - Street 1:7332 E BUTHERUS DR
Mailing Address - Street 2:HANGAR ONE
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2426
Mailing Address - Country:US
Mailing Address - Phone:480-734-7717
Mailing Address - Fax:480-247-6482
Practice Address - Street 1:607 SE EVERETT MALL WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3248
Practice Address - Country:US
Practice Address - Phone:425-265-7000
Practice Address - Fax:425-265-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-11
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care