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BROADWAY CLINIC INC NPI 1548370547


NPI Information

NPI: 1548370547
Provider Name: BROADWAY CLINIC INC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
104 W 4TH ST
SUITE # 105
ABERDEEN, WA
ZIP 98520
Phone: (360) 538-7292
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BROADWAY CLINIC INC is a family medicine in Aberdeen, WA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. BROADWAY CLINIC INC NPI is 1548370547. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

104 W 4TH ST
SUITE # 105
ABERDEEN, WA
ZIP 98520-932
Phone: (360) 538-7292
Fax: (360) 533-2566

The provider's authorized official is Antoine Douglass Johnson .
The authorized official title is Family Medicine Phyician Ceo Broawa and has the following contact phone number (360) 538-7292.

The enumeration date for this NPI number is 8/30/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17109903MEDICAIDWASHINGTON

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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