Provider Demographics
NPI:1952659393
Name:NORTHWEST PHYSICIANS LABORATORIES
Entity Type:Organization
Organization Name:NORTHWEST PHYSICIANS LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:JAE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-563-6263
Mailing Address - Street 1:2800 NORTHUP WAY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-1440
Mailing Address - Country:US
Mailing Address - Phone:425-563-6263
Mailing Address - Fax:425-642-8078
Practice Address - Street 1:2840 NORTHUP WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1464
Practice Address - Country:US
Practice Address - Phone:425-563-6263
Practice Address - Fax:425-642-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA50D2040375291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory