Provider Demographics
NPI:1275600660
Name:ASSOCIATED VALLEY OBSTETRICS AND GYNECOLOGY, INC., P.S.
Entity Type:Organization
Organization Name:ASSOCIATED VALLEY OBSTETRICS AND GYNECOLOGY, INC., P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-251-3454
Mailing Address - Street 1:4011 TALBOT RD S STE 430
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5791
Mailing Address - Country:US
Mailing Address - Phone:425-251-3454
Mailing Address - Fax:206-575-2616
Practice Address - Street 1:4011 TALBOT RD S STE 430
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5791
Practice Address - Country:US
Practice Address - Phone:425-251-3454
Practice Address - Fax:206-575-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2444907Medicaid
WA217129600Medicare PIN