Provider Demographics
NPI:1538112446
Name:EASTSIDE NEPHROLOGY AND HYPERTENSION PLLC
Entity Type:Organization
Organization Name:EASTSIDE NEPHROLOGY AND HYPERTENSION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMILA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KEECH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-990-8866
Mailing Address - Street 1:13030 121ST WAY NE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3008
Mailing Address - Country:US
Mailing Address - Phone:425-899-5111
Mailing Address - Fax:425-899-5114
Practice Address - Street 1:11711 NE 12TH ST
Practice Address - Street 2:SUITE 2 B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2461
Practice Address - Country:US
Practice Address - Phone:425-990-8866
Practice Address - Fax:425-990-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7108939Medicaid
WAGAB11026Medicare PIN