Organization
PRIME CARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN MOON (CONTRACTING COORDINATOR)
(206) 538-6300
Entity
Organization
Contact information
Practice address
11812 N CREEK PKWY N STE 202, BOTHELL, WA 98011-8202
(206) 538-6300
(206) 538-6301
Mailing address
801 SW 16TH ST STE 121, RENTON, WA 98057-2628
(206) 538-6300
(206) 538-6301
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
208VP0014X
Interventional Pain Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
12/19/2018
Last updated
02/09/2023
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