Provider Demographics
NPI:1588616080
Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON PC
Entity Type:Organization
Organization Name:DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON PC
Other - Org Name:DAVITA NEPHROLOGY PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT SECRETARY & TREASUR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EFTHIM
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-310-4872
Mailing Address - Street 1:PO BOX 60000 FILE #74521
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160-0001
Mailing Address - Country:US
Mailing Address - Phone:303-626-6234
Mailing Address - Fax:866-302-6807
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:SUITE 250
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-935-5423
Practice Address - Fax:206-935-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1346276797OtherRICHLAND NPI
WA7126378Medicaid
WA1346276797OtherRICHLAND NPI