Provider Demographics
NPI:1639297252
Name:PACIFIC UROLOGIC CONSULTANTS, P.S.
Entity Type:Organization
Organization Name:PACIFIC UROLOGIC CONSULTANTS, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORRAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-363-7675
Mailing Address - Street 1:1530 N 115TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8411
Mailing Address - Country:US
Mailing Address - Phone:206-363-7675
Mailing Address - Fax:206-363-7985
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8411
Practice Address - Country:US
Practice Address - Phone:206-363-7675
Practice Address - Fax:206-363-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB08691Medicare ID - Type UnspecifiedID