Provider Demographics
NPI:1477594885
Name:WASHINGTON INTERVENTIONAL SPINE ASSOCIATES, PS
Entity Type:Organization
Organization Name:WASHINGTON INTERVENTIONAL SPINE ASSOCIATES, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-454-1111
Mailing Address - Street 1:12301 NE 10TH PL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2487
Mailing Address - Country:US
Mailing Address - Phone:424-454-1111
Mailing Address - Fax:425-454-7653
Practice Address - Street 1:12301 NE 10TH PL
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2487
Practice Address - Country:US
Practice Address - Phone:424-454-1111
Practice Address - Fax:425-454-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB22943Medicare ID - Type UnspecifiedMEDICARE GROUP
WAE85597Medicare UPIN
WAE17360Medicare UPIN