Provider Demographics
NPI:1902188196
Name:PACIFIC NORTHWEST MEDICAL SERVICES PLLC
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST MEDICAL SERVICES PLLC
Other - Org Name:AFC URGENT CARE SOUTHCENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:TOAN
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD603437379
Authorized Official - Phone:425-291-3300
Mailing Address - Street 1:18012 W VALLEY HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98032-2924
Mailing Address - Country:US
Mailing Address - Phone:425-291-3300
Mailing Address - Fax:425-291-5300
Practice Address - Street 1:18012 W VALLEY HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1020
Practice Address - Country:US
Practice Address - Phone:425-291-3300
Practice Address - Fax:425-291-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8905992Medicare PIN