Provider Demographics
NPI:1700216223
Name:NORTHWEST ASTHMA ALLERGY CENTER
Entity Type:Organization
Organization Name:NORTHWEST ASTHMA ALLERGY CENTER
Other - Org Name:ALLERGY & ASTHMA CENTERS OF OLYMPIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-896-2222
Mailing Address - Street 1:PO BOX 821046
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0024
Mailing Address - Country:US
Mailing Address - Phone:360-896-2222
Mailing Address - Fax:360-896-8881
Practice Address - Street 1:3525 ENSIGN RD NE
Practice Address - Street 2:SUITE E
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5065
Practice Address - Country:US
Practice Address - Phone:360-896-2222
Practice Address - Fax:360-896-8881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST ASTHMA ALLERGY CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042579174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7119860Medicaid
WA7119860Medicaid