1235206558 NPI number — BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC

Table of content: (NPI 1235206558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235206558 NPI number — BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235206558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31001-1839
Provider Second Line Business Mailing Address:
BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-1839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-637-1022
Provider Business Mailing Address Fax Number:
425-637-2011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1750 112TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE A101 & A102
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-3782
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-637-1022
Provider Business Practice Location Address Fax Number:
425-637-2011
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
HENRY
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
425-637-1022

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X , with the licence number:  MD00024795 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0300X , with the licence number: 601913899 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7093594 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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