Provider Demographics
NPI:1154326890
Name:PMSI PACIFIC MOTHERS SUPPORT, INC.
Entity Type:Organization
Organization Name:PMSI PACIFIC MOTHERS SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:NOWIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-462-0577
Mailing Address - Street 1:1407 132ND AVE NE
Mailing Address - Street 2:STE 10
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2259
Mailing Address - Country:US
Mailing Address - Phone:425-462-0577
Mailing Address - Fax:425-462-0432
Practice Address - Street 1:1407 132ND AVE NE
Practice Address - Street 2:STE 10
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2259
Practice Address - Country:US
Practice Address - Phone:425-462-0577
Practice Address - Fax:425-462-0432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9036336Medicaid
WA0676160001Medicare ID - Type Unspecified