Provider Demographics
NPI:1730496092
Name:WASHINGTON UROLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:WASHINGTON UROLOGY ASSOCIATES, PLLC
Other - Org Name:WASHINGTON UROLOGY ASSOCIATES SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-454-8016
Mailing Address - Street 1:PO BOX 84454
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5754
Mailing Address - Country:US
Mailing Address - Phone:425-454-8016
Mailing Address - Fax:425-453-2827
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 620
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-454-8016
Practice Address - Fax:425-453-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8898898Medicare UPIN