Provider Demographics
NPI:1225199474
Name:RENTON PEDIATRIC ASSOCIATES, PS
Entity Type:Organization
Organization Name:RENTON PEDIATRIC ASSOCIATES, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHORR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-271-5437
Mailing Address - Street 1:4033 TALBOT RD S
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055
Mailing Address - Country:US
Mailing Address - Phone:425-271-5437
Mailing Address - Fax:425-656-4212
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:SUITE 200
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-271-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENTON PEDIATRIC ASSOCIATES, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-12
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7072390Medicaid