| Olympia Integrative Medicine | |
|
2610 Yelm Hwy Se Olympia WA 98501-4826 | |
| (360) 870-2011 | |
| (360) 925-3136 |
| Full Name | Olympia Integrative Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 2610 Yelm Hwy Se, Olympia, Washington |
| Authorized Official Name and Position | Thomas Etherton (PRESIDENT) |
| Authorized Official Contact | 3609159389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olympia Integrative Medicine 2610 Yelm Hwy Se Olympia WA 98501-4826 Ph: (360) 915-9389 | Olympia Integrative Medicine 2610 Yelm Hwy Se Olympia WA 98501-4826 Ph: (360) 870-2011 |
| NPI Number | 1518599273 |
|---|---|
| Provider Enumeration Date | 02/10/2020 |
| Last Update Date | 02/23/2021 |
| Certification Date | 02/23/2021 |
| Medicare PECOS PAC ID | 8628407079 |
|---|---|
| Medicare Enrollment ID | O20200406001398 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518599273 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | () | Primary |
| Provider Name | Thomas Lee Etherton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912547365 PECOS PAC ID: 9537598982 Enrollment ID: I20200406001799 |
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