Provider Demographics
NPI:1629466917
Name:PACIFIC NORTHWEST MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST MEDICAL SERVICES PLLC
Other - Org Name:AFC URGENT CARE SEATTLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-291-3300
Mailing Address - Street 1:18012 W VALLEY HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2924
Mailing Address - Country:US
Mailing Address - Phone:425-291-3300
Mailing Address - Fax:425-291-5300
Practice Address - Street 1:116 FAIRVIEW AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5360
Practice Address - Country:US
Practice Address - Phone:206-718-0742
Practice Address - Fax:253-813-3686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8908324Medicare PIN
WAG8905992Medicare PIN