Provider Demographics
NPI:1356005458
Name:PUGET SOUND KIDNEY CENTERS
Entity Type:Organization
Organization Name:PUGET SOUND KIDNEY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-259-5195
Mailing Address - Street 1:1019 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4148
Mailing Address - Country:US
Mailing Address - Phone:425-259-1884
Mailing Address - Fax:425-258-9610
Practice Address - Street 1:2500 W SIMS WAY STE 102
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-2234
Practice Address - Country:US
Practice Address - Phone:360-379-9605
Practice Address - Fax:360-379-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-25
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment