Provider Demographics
NPI:1316393036
Name:HEALTH HEROES PNW, INC.
Entity Type:Organization
Organization Name:HEALTH HEROES PNW, INC.
Other - Org Name:HEALTH HEROES OF THE PACIFIC NORTHWEST
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:206-419-1815
Mailing Address - Street 1:23418 PACIFIC HWY S
Mailing Address - Street 2:PO BOX 3104
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-9994
Mailing Address - Country:US
Mailing Address - Phone:206-419-1815
Mailing Address - Fax:
Practice Address - Street 1:720 S 320TH ST
Practice Address - Street 2:STE E
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5254
Practice Address - Country:US
Practice Address - Phone:206-419-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603-607-7472083P0901X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty