1568729572 NPI number — BEST NORTHWEST PHYSICIANS PLLC

Table of content: (NPI 1568729572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568729572 NPI number — BEST NORTHWEST PHYSICIANS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEST NORTHWEST PHYSICIANS 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:
6
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:
1568729572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6300 SAND POINT WAY NE
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98115-7972
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-737-5764
Provider Business Mailing Address Fax Number:
253-220-2127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21709 113TH ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNEY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98391-7844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-737-5764
Provider Business Practice Location Address Fax Number:
253-220-2127
Provider Enumeration Date:
04/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
RUDNICK
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
MILES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-737-5764

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MD00043225 , 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)





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