Provider Demographics
NPI:1700025038
Name:NORTHWEST KIDNEY CENTERS
Entity Type:Organization
Organization Name:NORTHWEST KIDNEY CENTERS
Other - Org Name:NORTHWEST KIDNEY CENTERS DBA BROADWAY KIDNEY CENTER
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:206-292-2771
Mailing Address - Fax:206-292-2133
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:206-720-3816
Practice Address - Fax:206-292-2133
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST KIDNEY CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-10
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA502556Medicare Oscar/Certification