Provider Demographics
NPI:1528013828
Name:EVERETT CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:EVERETT CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES
Other - Org Name:PACIFIC NORTHWEST SURGICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:BREVIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-339-3633
Mailing Address - Street 1:1330 ROCKEFELLER AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1684
Mailing Address - Country:US
Mailing Address - Phone:425-339-3633
Mailing Address - Fax:425-259-1845
Practice Address - Street 1:1330 ROCKEFELLER AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1684
Practice Address - Country:US
Practice Address - Phone:425-339-3633
Practice Address - Fax:425-259-1845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty