Provider Demographics
NPI:1558337527
Name:EASTSIDE UROLOGY ASSOCIATES PS
Entity Type:Organization
Organization Name:EASTSIDE UROLOGY ASSOCIATES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-899-5801
Mailing Address - Street 1:11911 NE 132ND ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2900
Mailing Address - Country:US
Mailing Address - Phone:425-899-5800
Mailing Address - Fax:425-899-5806
Practice Address - Street 1:11911 NE 132ND ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2900
Practice Address - Country:US
Practice Address - Phone:425-899-5800
Practice Address - Fax:425-899-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA36112208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAI10719GOtherMEDICARE ID-PIN
WAA05679GOtherMEDICARE ID-PIN
WAI13494GOtherMEDICARE ID-PIN
WAI62620GOtherMEDICARE ID-PIN
WAA55329GOtherMEDICARE ID-PIN
WAH31729GOtherMEDICARE ID-PIN
WAI62620GOtherMEDICARE ID-PIN
A05679Medicare UPIN
WAI13494GOtherMEDICARE ID-PIN
A55329Medicare UPIN
H31729Medicare UPIN