Provider Demographics
NPI:1427000546
Name:NEB DOCTORS OF WASHINGTON, LLC
Entity Type:Organization
Organization Name:NEB DOCTORS OF WASHINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-802-2323
Mailing Address - Street 1:718 GRIFFIN AVE
Mailing Address - Street 2:#284
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3418
Mailing Address - Country:US
Mailing Address - Phone:360-802-2323
Mailing Address - Fax:360-802-6565
Practice Address - Street 1:844 MT VILLA ST
Practice Address - Street 2:SUITE A
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2902
Practice Address - Country:US
Practice Address - Phone:360-802-2323
Practice Address - Fax:360-802-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9057167Medicaid
WA9057167Medicaid