1942394853 NPI number — BRENT R. WENDEL, DPM, INC, P.S.

Table of content: (NPI 1942394853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942394853 NPI number — BRENT R. WENDEL, DPM, INC, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRENT R. WENDEL, DPM, 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:
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:
1942394853
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 BROADWAY
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122-5373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-860-4300
Provider Business Mailing Address Fax Number:
206-860-0907

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98122-5373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-860-4300
Provider Business Practice Location Address Fax Number:
206-860-0907
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WENDEL
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
206-860-4300

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO00000621 , 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: 101063 . This is a "LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1106616 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com