Provider Demographics
NPI:1578507919
Name:NORTHWEST KIDNEY CENTERS
Entity Type:Organization
Organization Name:NORTHWEST KIDNEY CENTERS
Other - Org Name:NORTHWEST KIDNEY CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCABE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-720-8508
Mailing Address - Street 1:700 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-4302
Mailing Address - Country:US
Mailing Address - Phone:206-343-4870
Mailing Address - Fax:206-343-4884
Practice Address - Street 1:700 BROADWAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4302
Practice Address - Country:US
Practice Address - Phone:206-343-4870
Practice Address - Fax:206-343-4884
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST KIDNEY CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACF00003625333600000X
ID20609MS3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2108628OtherPK
WA6012975Medicaid
WA6012975Medicaid