NPIMap

Organization Active NPI

Medtriq Treatment Center LLC

  • Clinic/Center
  • University Place, WA
National Provider Identifier
1215446729
Registry record updated Jan 29, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
604172507 Issued in WA
Legal business name
MEDTRIQ TREATMENT CENTER LLC
Practice address
2603 Bridgeport Way W Ste F
University Place, WA 98466-4724
Phone
(253) 666-6780
Fax
(253) 666-6793
NPI assigned
Sep 27, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2018

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

Authorized official

Name
Dr. Ajainder Shergill, DO
Title
Owner
Phone
(360) 334-1882

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 604172507 WA Primary

Addresses

Primary practice location

2603 Bridgeport Way W Ste F
University Place, WA 98466-4724

Mailing address

1567 Highlands Dr NE Ste 110-345
Issaquah, WA 98029-6245

National Provider Directory

National Provider Directory

Locations

1567 Highlands Dr NE
Ste 110345
Issaquah, WA 98029

NPI Registry JSON

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

{
    "created_epoch": "1506470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517184000000",
    "number": "1215446729",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1567 HIGHLANDS DR NE STE 110-345",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980296245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2603 BRIDGEPORT WAY W STE F",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984664724",
            "telephone_number": "253-666-6780",
            "fax_number": "253-666-6793"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDTRIQ TREATMENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-27",
        "last_updated": "2018-01-29",
        "status": "A",
        "authorized_official_last_name": "SHERGILL",
        "authorized_official_first_name": "AJAINDER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-334-1882",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "604172507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; 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.