Provider Demographics
NPI:1659446938
Name:NORTHWEST ASTHMA & ALLERGY CENTER
Entity Type:Organization
Organization Name:NORTHWEST ASTHMA & ALLERGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-527-2577
Mailing Address - Street 1:4540 SAND POINT WAY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3941
Mailing Address - Country:US
Mailing Address - Phone:206-527-1200
Mailing Address - Fax:
Practice Address - Street 1:3901 CREEKSIDE LOOP
Practice Address - Street 2:SUITE 100
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-4801
Practice Address - Country:US
Practice Address - Phone:509-966-3259
Practice Address - Fax:509-966-0191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST ASTHMA & ALLERGY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7701808Medicaid
WAC19081OtherRAILROAD MEDICARE
WAC19081OtherRAILROAD MEDICARE