1881789006 NPI number — NORTHWEST KIDNEY CENTERS

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 1881789006 NPI number — NORTHWEST KIDNEY CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST KIDNEY CENTERS
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:
1881789006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12901 20TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATAC
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98168-5159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-292-2771
Provider Business Mailing Address Fax Number:
206-860-5821

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 W VALLEY HWY N STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98001-1606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-720-3816
Provider Business Practice Location Address Fax Number:
206-292-2133
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESLAVA
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
206-292-2771

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0251 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 159 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1046062 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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