Provider Demographics
NPI:1093819286
Name:NORTHWEST NEUROLOGICAL & NEUROVASCULAR SERVICES
Entity Type:Organization
Organization Name:NORTHWEST NEUROLOGICAL & NEUROVASCULAR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VASCULAR NEUROLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:C
Authorized Official - Last Name:HEIDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-264-2568
Mailing Address - Street 1:500 SW 39TH ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4915
Mailing Address - Country:US
Mailing Address - Phone:425-264-2568
Mailing Address - Fax:425-264-2569
Practice Address - Street 1:500 SW 39TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4915
Practice Address - Country:US
Practice Address - Phone:425-264-2568
Practice Address - Fax:425-264-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040593261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862129Medicare PIN