1770826927 NPI number — HOUSE, LEE, MAST, MCDONALD AND NELSON, PC

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 1770826927 NPI number — HOUSE, LEE, MAST, MCDONALD AND NELSON, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOUSE, LEE, MAST, MCDONALD AND NELSON, PC
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:
1770826927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
451 DUVALL AVE NE
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98059-4675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-228-5437
Provider Business Mailing Address Fax Number:
425-663-7990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
451 DUVALL AVE NE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98059-4675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-228-5437
Provider Business Practice Location Address Fax Number:
425-663-7990
Provider Enumeration Date:
04/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MCINTOSH
Authorized Official First Name:
LANETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL OPERATIONS MANAGER
Authorized Official Telephone Number:
425-396-1011

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5048921 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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