1669643649 NPI number — WELLNESSONE OF BELLEVUE, PS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669643649 NPI number — WELLNESSONE OF BELLEVUE, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WELLNESSONE OF BELLEVUE, PS
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:
1669643649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14700 NE 8TH ST
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98007-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-644-8386
Provider Business Mailing Address Fax Number:
425-644-2560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14700 NE 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-644-8386
Provider Business Practice Location Address Fax Number:
425-644-2560
Provider Enumeration Date:
03/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
THAIN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
PAULL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-644-8386

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  601313477 , 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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