Provider Demographics
NPI:1710126909
Name:PACIFIC RHEUMATOLOGY ASSOCIATES INC PS
Entity Type:Organization
Organization Name:PACIFIC RHEUMATOLOGY ASSOCIATES INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-235-9500
Mailing Address - Street 1:4300 TALBOT RD S
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-6238
Mailing Address - Country:US
Mailing Address - Phone:425-235-9500
Mailing Address - Fax:425-235-9555
Practice Address - Street 1:4300 TALBOT RD S
Practice Address - Street 2:SUITE 101
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:425-235-9500
Practice Address - Fax:425-235-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB32289Medicare PIN