Provider Demographics
NPI:1356386783
Name:OLYMPIA MULTI SPECIALTY CLINIC
Entity type:Organization
Organization Name:OLYMPIA MULTI SPECIALTY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-704-3450
Mailing Address - Street 1:406 BLACK HILLS LN SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8144
Mailing Address - Country:US
Mailing Address - Phone:360-704-3450
Mailing Address - Fax:360-754-1783
Practice Address - Street 1:406 BLACK HILLS LN SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8143
Practice Address - Country:US
Practice Address - Phone:360-704-3450
Practice Address - Fax:360-754-1783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0517888174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty