Market Street Clinic
LBN: Thomas C Gustafson
Market Street Clinic is an health care organization with primary practice located at 1717 Nw Market St , Seattle WA 98107-5225. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Physician Assistants & Advanced Practice Nursing Providers / Family. Allopathic & Osteopathic Physicians / General Practice is the primary health care specialty.
Thomas C Gustafson can be contacted via phone (206) 782-0500, or through Gustafson, Thomas Carl via phone (206) 782-0500.
Contact Information
Primary practice address
1717 Nw Market St
Seattle WA 98107-5225
Phone: (206) 782-0500
Fax: (206) 782-0502
Website:
Authorized official contact:
Name: Gustafson, Thomas Carl Doctor of Osteopathy (DO)
Phone: (206) 782-0500
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / General Practice | 208D00000X | OP00001187 | Washington |
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | AP30007148 | Washington |
Profile Details
| NPI number | 1821213612 |
|---|---|
| LBN Legal business name | Thomas C Gustafson |
| DBA Doing business as | Market Street Clinic |
| Authorized official | Gustafson, Thomas Carl Doctor of Osteopathy (DO) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Apr 16th, 2007 |
| Last updated | Jul 14th, 2008 - about 18 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821213612 | NPPES |
| Washington | MEDICAID | 9647421 | |
| Washington | MEDICAID | 1046325 |
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