Provider Demographics
NPI:1336310382
Name:EVERETT E N T PS INC
Entity Type:Organization
Organization Name:EVERETT E N T PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-258-4361
Mailing Address - Street 1:5929 EVERGREEN WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-6031
Mailing Address - Country:US
Mailing Address - Phone:425-258-4361
Mailing Address - Fax:425-259-5270
Practice Address - Street 1:5929 EVERGREEN WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-6031
Practice Address - Country:US
Practice Address - Phone:425-258-4361
Practice Address - Fax:425-259-5270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025076207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAD33834Medicare UPIN
WAE43071Medicare UPIN