Provider Demographics
NPI:1205015112
Name:PACIFIC NORTHWEST UROGYNECOLOGY PLLC
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST UROGYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDRE
Authorized Official - Last Name:SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-658-7652
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98009-0128
Mailing Address - Country:US
Mailing Address - Phone:360-329-7897
Mailing Address - Fax:360-925-2898
Practice Address - Street 1:903 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-1697
Practice Address - Country:US
Practice Address - Phone:360-329-7897
Practice Address - Fax:360-925-2898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044925174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1205015112OtherMEDICAID BILLING PROVIDER #
1205015112OtherTYPE 2 (GROUP/ORGANIZATIONAL) NPI
WA2025944OtherPROVIDER ONE # (LINKED TO TYPE 2 NPI)
WA0307100OtherL&I
1861413965OtherTYPE 1 (INDIVIDUAL) NPI
WAG8917674OtherMEDICARE PTAN FOR INDIVIDUAL (ARLINGTON, WA)
WA1861413965OtherMEDICAID RENDERING PROVIDER #
WAG8917673OtherMEDICARE PTAN FOR GROUP (ARLINGTON, WA)