Provider Demographics
NPI:1558149807
Name:PUGET SOUND KIDNEY CENTERS
Entity Type:Organization
Organization Name:PUGET SOUND KIDNEY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING & CONTRACTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:LONDERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-259-1884
Mailing Address - Street 1:1019 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4148
Mailing Address - Country:US
Mailing Address - Phone:425-259-5195
Mailing Address - Fax:425-258-9610
Practice Address - Street 1:357 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3101
Practice Address - Country:US
Practice Address - Phone:425-259-5195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment