Provider Demographics
NPI:1891991956
Name:TRANSPLANT AND NEPHROLOGY NORTHWEST PLLC
Entity Type:Organization
Organization Name:TRANSPLANT AND NEPHROLOGY NORTHWEST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLYNIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-709-2009
Mailing Address - Street 1:2150 N 107TH ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-1305
Mailing Address - Country:US
Mailing Address - Phone:206-709-2009
Mailing Address - Fax:206-709-2019
Practice Address - Street 1:2150 N 107TH ST
Practice Address - Street 2:SUITE 520
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-1305
Practice Address - Country:US
Practice Address - Phone:206-709-2009
Practice Address - Fax:206-709-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7109598Medicaid
WAX67979Medicare UPIN
WAAB26471Medicare ID - Type Unspecified