Provider Demographics
NPI:1073581807
Name:ISSAQUAH OBSTETRICS AND GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:ISSAQUAH OBSTETRICS AND GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-391-8886
Mailing Address - Street 1:6520 226TH PL SE
Mailing Address - Street 2:STE 120
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027
Mailing Address - Country:US
Mailing Address - Phone:425-391-8886
Mailing Address - Fax:425-394-1087
Practice Address - Street 1:6520 226TH PL SE
Practice Address - Street 2:STE 120
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027
Practice Address - Country:US
Practice Address - Phone:425-391-8886
Practice Address - Fax:425-394-1087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7126436Medicaid
WA7126436Medicaid