| Providence Express Care | |
|
800 Fifth Ave Ste 900 Seattle WA 98104-3179 | |
| (888) 327-3312 | |
| Not Available |
| Full Name | Providence Express Care |
|---|---|
| Speciality | Clinic/Center |
| Location | 800 Fifth Ave Ste 900, Seattle, Washington |
| Authorized Official Name and Position | Donald W Anderson (ASST SEC FOR ENROLLMENT/DIR REIMB) |
| Authorized Official Contact | 4255255392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Express Care Po Box 3229 Portland OR 97208-3229 Ph: (888) 227-3312 | Providence Express Care 800 Fifth Ave Ste 900 Seattle WA 98104-3179 Ph: (888) 327-3312 |
| NPI Number | 1205499126 |
|---|---|
| Provider Enumeration Date | 04/16/2019 |
| Last Update Date | 10/05/2021 |
| Medicare PECOS PAC ID | 1254768732 |
|---|---|
| Medicare Enrollment ID | O20200221001693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205499126 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Carrie Lynne Myers-cleary |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760416325 PECOS PAC ID: 7214927813 Enrollment ID: I20040515000123 |
| Provider Name | Kimberly S Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578870069 PECOS PAC ID: 3476781055 Enrollment ID: I20140103000669 |
| Provider Name | Kristin K Loch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730197294 PECOS PAC ID: 1850377102 Enrollment ID: I20141201001540 |
| Provider Name | Steven Beardsley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457903239 PECOS PAC ID: 7416389457 Enrollment ID: I20200224001052 |
| Provider Name | Olubanke Babalola |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013329002 PECOS PAC ID: 9133345275 Enrollment ID: I20200605001926 |
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