| Picacs Clinic | |
|
10634 E Riverside Dr Suite 300 Bothell WA 98011-3757 | |
| (425) 412-6318 | |
| Not Available |
| Full Name | Picacs Clinic |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 10634 E Riverside Dr, Bothell, Washington |
| Authorized Official Name and Position | Syed Jamal Mustafa (MEDICAL DIRECTOR) |
| Authorized Official Contact | 4258065021 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Picacs Clinic 10634 E Riverside Dr Suite 300 Bothell WA 98011-3757 Ph: (425) 412-6318 | Picacs Clinic 10634 E Riverside Dr Suite 300 Bothell WA 98011-3757 Ph: (425) 412-6318 |
| NPI Number | 1467905695 |
|---|---|
| Provider Enumeration Date | 07/23/2016 |
| Last Update Date | 07/23/2016 |
| Medicare PECOS PAC ID | 0143596940 |
|---|---|
| Medicare Enrollment ID | O20171023002865 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467905695 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 200385 (Washington) | Primary |
| Provider Name | Syed J Mustafa |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609883180 PECOS PAC ID: 2365533544 Enrollment ID: I20070801000767 |
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