Provider Demographics
NPI:1760620462
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:206-527-2577
Mailing Address - Fax:206-527-2514
Practice Address - Street 1:22635 NE MARKETPLACE DR
Practice Address - Street 2:SUITE 110
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-5885
Practice Address - Country:US
Practice Address - Phone:206-527-2577
Practice Address - Fax:206-527-2514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORHTWEST ASTHMA & ALLERGY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-03
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600 176 916207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP7653OtherRAIL ROAD MEDICARE
WAG215100200Medicare PIN