Provider Demographics
NPI:1497706774
Name:JOHN H. ADDISON MD PS
Entity Type:Organization
Organization Name:JOHN H. ADDISON MD PS
Other - Org Name:NORTHWEST GERIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-275-3588
Mailing Address - Street 1:PO BOX 1526
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:206-275-3588
Mailing Address - Fax:206-275-2073
Practice Address - Street 1:9725 SE 36TH ST.
Practice Address - Street 2:SUITE 214
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040
Practice Address - Country:US
Practice Address - Phone:206-275-3588
Practice Address - Fax:206-275-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0300X
WA207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB33253Medicare UPIN
WAGAB33253Medicare ID - Type Unspecified