Broadway Clinic Inc

LBN: Broadway Clinic Inc
Broadway Clinic Inc is an health care organization with primary practice located at 104 W 4Th St Suite # 105, Aberdeen WA 98520-3932. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as the primary health care specialty. Broadway Clinic Inc can be contacted via phone (360) 538-7292, or through Johnson, Antoine Douglass via phone (360) 538-7292.

Contact Information

Primary practice address
104 W 4Th St Suite # 105 Aberdeen WA 98520-3932
Phone: (360) 538-7292
Fax: (360) 533-2566
Website:
Map and Directions
Authorized official contact:
Name: Johnson, Antoine Douglass Doctor of Medicine (MD)
Phone: (360) 538-7292

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X

Profile Details

NPI number 1548370547
LBN Legal business name Broadway Clinic Inc
DBA Doing business as
Authorized official Johnson, Antoine Douglass Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 30th, 2006
Last updated Aug 22nd, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1548370547 NPPES
Washington MEDICAID 7109903

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