# BROADWAY CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548370547
- **Authorized official:** DR. ANTOINE DOUGLASS JOHNSON MD (FAMILY MEDICINE PHYICIAN CEO BROAWA)
- **Authorized official phone:** (360) 538-7292

## Contact information

- **Practice address:** 104 W 4TH ST, SUITE \# 105, ABERDEEN, WA 98520-3932
- **Practice address phone:** (360) 538-7292
- **Practice address fax:** (360) 533-2566
- **Mailing address:** PO BOX 149, ABERDEEN, WA 98520-0063
- **Mailing address phone:** (360) 538-7292
- **Mailing address fax:** (360) 533-2566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2006
- **Last updated:** 08/22/2020