Provider Demographics
NPI:1083210025
Name:NEO PACIFIC CORP
Entity Type:Organization
Organization Name:NEO PACIFIC CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-301-1900
Mailing Address - Street 1:22039 NE 74TH PL
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-7776
Mailing Address - Country:US
Mailing Address - Phone:425-301-1900
Mailing Address - Fax:
Practice Address - Street 1:4636 E MARGINAL WAY S STE B250
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2376
Practice Address - Country:US
Practice Address - Phone:206-455-8970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEO PACIFIC CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No291U00000XLaboratoriesClinical Medical Laboratory