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104th Avenue Medical Clinic Incorporated
Clinic/Center in Kent, Washington
NPI 1396921326

104th Avenue Medical Clinic Incorporated is a Clinic/Center based in Kent, WA. 104th Avenue Medical Clinic Incorporated practices in Kent, WA. The NPI Number for 104th Avenue Medical Clinic Incorporated is 1396921326 and holds a License No. 37861 (Washington).

The current practice location address for 104th Avenue Medical Clinic Incorporated is 24604 104Th Ave Se, Kent, WA and can be reached out via phone at 253-859-8371 and via fax at 253-859-9593.

Location: 24604 104Th Ave Se, Kent, WA, 98030-5385
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1396921326
Provider Name
104th Avenue Medical Clinic Incorporated
Credential
Provider Entity Type
Organization
Address
24604 104Th Ave Se, Kent, WA, 98030-5385
Phone Number
253-859-8371
Fax Number
253-859-9593
Provider Enumeration Date
01/22/2008
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1110378 05 WA
institution
Provider Business Practice Location Address Details
Address
24604 104Th Ave Se
City
Kent
State
Washington
Zip
98030-5385
Phone Number
253-859-8371
Fax Number
253-859-9593
person
Provider Business Mailing Address Details
Address
24604 104Th Ave Se
City
Kent
State
Washington
Zip
98030-5385
Phone Number
253-859-8371
Fax Number
253-859-9593
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
-
Taxonomy
261Q00000X
License No.
37861 (Washington)
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
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