Provider Demographics
NPI:1952852873
Name:PACIFIC NORTHWEST UROLOGY SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:PACIFIC NORTHWEST UROLOGY SPECIALISTS, PLLC
Other - Org Name:PACIFIC NORTHWEST UROLOGY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REANNA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FURNARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-733-7687
Mailing Address - Street 1:PO BOX 32150
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98228-4150
Mailing Address - Country:US
Mailing Address - Phone:360-733-7687
Mailing Address - Fax:360-734-7687
Practice Address - Street 1:3232 SQUALICUM PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1932
Practice Address - Country:US
Practice Address - Phone:360-733-7687
Practice Address - Fax:360-734-7687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical