1770645053 NPI number — NORTHWEST GASTROENTEROLOGY ASSOCIATES, INC., P.S,.

Table of content: (NPI 1770645053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770645053 NPI number — NORTHWEST GASTROENTEROLOGY ASSOCIATES, INC., P.S,.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST GASTROENTEROLOGY ASSOCIATES, INC., P.S,.
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:
1770645053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1135 116TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 560
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98004-4623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-454-4768
Provider Business Mailing Address Fax Number:
425-462-8021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1135 116TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 560
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004-4623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-454-4768
Provider Business Practice Location Address Fax Number:
425-462-8021
Provider Enumeration Date:
12/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WOHLMAN
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
425-990-2721

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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