Provider Demographics
NPI:1114937919
Name:NORTH SOUND EMERGENCY MEDICINE PC
Entity Type:Organization
Organization Name:NORTH SOUND EMERGENCY MEDICINE PC
Other - Org Name:EMERGENCY PHYSICIANS MEDICAL GROUP NORTHWEST PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCKHAUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-595-2220
Mailing Address - Street 1:PO BOX 84203
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 13TH ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1689
Practice Address - Country:US
Practice Address - Phone:425-261-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7094634Medicaid
WA7094634Medicaid
WACI9766Medicare PIN