1629466917 NPI number — PACIFIC NORTHWEST MEDICAL SERVICES PLLC

Table of content: (NPI 1629466917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629466917 NPI number — PACIFIC NORTHWEST MEDICAL SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC NORTHWEST MEDICAL SERVICES 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:
1629466917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18012 W VALLEY HWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
KENT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98032-2924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-291-3300
Provider Business Mailing Address Fax Number:
425-291-5300

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 FAIRVIEW AVE N
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:
98109-5360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-718-0742
Provider Business Practice Location Address Fax Number:
253-813-3686
Provider Enumeration Date:
01/08/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
T
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
425-291-3300

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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