NPIMap

Organization Active NPI

Longevity Medical Clinic

  • Specialist
  • Kirkland, WA
National Provider Identifier
1023231172
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MD23643 Issued in WA
Legal business name
LONGEVITY MEDICAL CLINIC
Practice address
9757 NE Juanita Dr
Suite 200
Kirkland, WA 98034-4299
Phone
(425) 576-9272
Fax
(425) 576-0894
NPI assigned
Apr 10, 2007
Last updated
Jun 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Jerry N Mixon, M.D.NPI 1366799090
Title
Medical Director
Phone
(425) 576-9272

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MD23643 WA Primary

Addresses

Primary practice location

9757 NE Juanita Dr
Suite 200
Kirkland, WA 98034-4299

Mailing address

9757 NE Juanita Dr
Suite 200
Kirkland, WA 98034-4299
Phone (425) 576-9272

National Provider Directory

National Provider Directory

Locations

9757 NE Juanita Dr
Ste 200
Kirkland, WA 98034
Phone (425) 322-7766

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308614400000",
    "number": "1023231172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9757 NE JUANITA DR",
            "address_2": "SUITE 200",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344299",
            "telephone_number": "425-576-9272",
            "fax_number": "425-576-0894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9757 NE JUANITA DR",
            "address_2": "SUITE 200",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344299",
            "telephone_number": "425-576-9272",
            "fax_number": "425-576-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGEVITY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2011-06-21",
        "status": "A",
        "authorized_official_last_name": "MIXON",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "425-576-9272",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD23643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.