Organization Active NPI

Olympic Valley Clinic, PLLC

  • Primary Care Clinic/Center
  • Elma, WA
National Provider Identifier
1710601299
Registry record updated Sep 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
OLYMPIC VALLEY CLINIC, PLLC
Practice address
11 Schouweiler Rd
Elma, WA 98541-9306
Phone
(360) 482-5300
Fax
(360) 482-5900
NPI assigned
Sep 28, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2022

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

Authorized official

Name
Ashley M Taylor, ARNPNPI 1598358277
Title
Provider/Owner
Phone
(360) 485-0046

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

11 Schouweiler Rd
Elma, WA 98541-9306

Mailing address

1905 Owen Dr
Montesano, WA 98563-9761
Phone (360) 451-8719

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230124003238 WA Part B Supplier - Clinic/Group Practice 5092186387 Receives reassigned benefits from 4 practitioners
Practice locations: Elma, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2307027Olympic Valley Clinic11 Schouweiler Rd, Elma, WA 98541Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1710601299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 OWEN DR",
            "city": "MONTESANO",
            "state": "WA",
            "postal_code": "985639761",
            "telephone_number": "360-451-8719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 SCHOUWEILER RD",
            "city": "ELMA",
            "state": "WA",
            "postal_code": "985419306",
            "telephone_number": "360-482-5300",
            "fax_number": "360-482-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC VALLEY CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "360-485-0046",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.