Provider Demographics
NPI:1417552944
Name:RAINIER INTEGRATED PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:RAINIER INTEGRATED PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GOVERNOR/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:NABATANZI
Authorized Official - Middle Name:AGNES
Authorized Official - Last Name:BEWAYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:971-251-5788
Mailing Address - Street 1:PO BOX 58608
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-1608
Mailing Address - Country:US
Mailing Address - Phone:971-251-5788
Mailing Address - Fax:
Practice Address - Street 1:402 S 333RD ST STE 105
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7099
Practice Address - Country:US
Practice Address - Phone:971-251-5788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care