1992738918 NPI number — QUEEN ANNE OBSTETRICS AND GYNECOLOGY

Table of content: (NPI 1992738918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992738918 NPI number — QUEEN ANNE OBSTETRICS AND GYNECOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUEEN ANNE OBSTETRICS AND GYNECOLOGY
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:
1992738918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W MERCER ST STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98119-3954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-781-1830
Provider Business Mailing Address Fax Number:
206-283-3640

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 W MERCER ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98119-3954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-781-1830
Provider Business Practice Location Address Fax Number:
206-283-3640
Provider Enumeration Date:
07/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
YUN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
206-781-1830

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  602256276 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7114788 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".