Provider Demographics
NPI:1992759815
Name:MEDCARE CLINICS LTD
Entity type:Organization
Organization Name:MEDCARE CLINICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:REINIER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN COEVORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-557-4227
Mailing Address - Street 1:1490 NW GILMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5327
Mailing Address - Country:US
Mailing Address - Phone:425-557-4227
Mailing Address - Fax:425-557-2858
Practice Address - Street 1:1490 NW GILMAN BLVD
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5327
Practice Address - Country:US
Practice Address - Phone:425-557-4227
Practice Address - Fax:425-557-2858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031289305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF76483Medicare UPIN
WAGAB00904Medicare PIN