Provider Demographics
NPI:1902885635
Name:CAREPLUS MEDICAL CENTERS, INC
Entity type:Organization
Organization Name:CAREPLUS MEDICAL CENTERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JERILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-365-0220
Mailing Address - Street 1:14731 AURORA AVE N
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6547
Mailing Address - Country:US
Mailing Address - Phone:206-365-0220
Mailing Address - Fax:206-365-6436
Practice Address - Street 1:14731 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6547
Practice Address - Country:US
Practice Address - Phone:206-365-0220
Practice Address - Fax:206-365-6436
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAREPLUS MEDICAL CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-11
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00014966207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7066608Medicaid
WA0997860001Medicare NSC
WA7066608Medicaid