1841379369 NPI number — SEATTLE EAR NOSE THROAT TR

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 1841379369 NPI number — SEATTLE EAR NOSE THROAT TR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEATTLE EAR NOSE THROAT TR
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:
1841379369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98046-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-712-3417
Provider Business Mailing Address Fax Number:
425-712-3710

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10330 MERIDIAN AVE N
Provider Second Line Business Practice Location Address:
SUITE 190
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-9451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-389-7100
Provider Business Practice Location Address Fax Number:
206-389-7101
Provider Enumeration Date:
11/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
206-389-7100

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  MD00045832 , 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)

  • Identifier: P00377059 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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