| Whidbey Medical Clinic Pllc | |
|
231 Se Barrington Dr Suite 209 Oak Harbor WA 98277-3200 | |
| (360) 679-3161 | |
| (360) 679-1741 |
| Full Name | Whidbey Medical Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 231 Se Barrington Dr, Oak Harbor, Washington |
| Authorized Official Name and Position | Robert L Lycksell (OWNER) |
| Authorized Official Contact | 3606793161 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Whidbey Medical Clinic Pllc 231 Se Barrington Dr Suite 209 Oak Harbor WA 98277-3200 Ph: (360) 679-3161 | Whidbey Medical Clinic Pllc 231 Se Barrington Dr Suite 209 Oak Harbor WA 98277-3200 Ph: (360) 679-3161 |
| NPI Number | 1548260177 |
|---|---|
| Provider Enumeration Date | 07/26/2005 |
| Last Update Date | 12/04/2009 |
| Medicare PECOS PAC ID | 5890683031 |
|---|---|
| Medicare Enrollment ID | O20040309000368 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548260177 | NPI | - | NPPES |
| S57923 | Other | WA | BLUE CROSS/SHIELD |
| CC9056 | Other | WA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Zayan Kanjo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407830441 PECOS PAC ID: 4486759719 Enrollment ID: I20100719000131 |
| Provider Name | Robert Lee Lycksell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922085901 PECOS PAC ID: 9032214366 Enrollment ID: I20100719000153 |
| Provider Name | Michael David Thorpe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578666848 PECOS PAC ID: 9133297336 Enrollment ID: I20160818002289 |
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