Provider Demographics
NPI:1548250012
Name:MINOR & JAMES MEDICAL PLLC
Entity type:Organization
Organization Name:MINOR & JAMES MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-386-9500
Mailing Address - Street 1:PO BOX 26947
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84126-0947
Mailing Address - Country:US
Mailing Address - Phone:206-386-9500
Mailing Address - Fax:206-386-9605
Practice Address - Street 1:515 MINOR AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2120
Practice Address - Country:US
Practice Address - Phone:206-386-9500
Practice Address - Fax:206-386-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7136872OtherAUDIOLOGY MEDICAID
WA7139439OtherMEDICARE ASC/FHSC
144182OtherL&I LABORATORY
7027352OtherMEDICAID ASC
WA9060666OtherMEDICAID HEARING AIDS
501034OtherMEDICARE/ASC CERT
WA5891740001OtherDME
WA7022544Medicaid
WA215831OtherL&I ASC/FHSC
163569OtherL&I ASC
8901651OtherL&I CRIME VICTIMS
WA78900OtherLI
CE1300OtherPALMETTA GBA /RR MEDICARE
501034OtherMEDICARE/ASC CERT
W22677Medicare UPIN
WA5891740001Medicare NSC