Provider Demographics
NPI:1942593165
Name:VINCENT N MUONEKE MD PS
Entity Type:Organization
Organization Name:VINCENT N MUONEKE MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:N
Authorized Official - Last Name:MUONEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PS
Authorized Official - Phone:206-248-6992
Mailing Address - Street 1:16233 SYLVESTER RD SW
Mailing Address - Street 2:SUITE 280
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3045
Mailing Address - Country:US
Mailing Address - Phone:206-248-6992
Mailing Address - Fax:206-248-7363
Practice Address - Street 1:16233 SYLVESTER RD SW
Practice Address - Street 2:SUITE 280
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3045
Practice Address - Country:US
Practice Address - Phone:206-248-6992
Practice Address - Fax:206-248-7363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-20
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027931208200000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1094879Medicaid
WAE72308Medicare UPIN