Provider Demographics
NPI:1962673905
Name:SEATTLE NEUROLOGY, PS
Entity Type:Organization
Organization Name:SEATTLE NEUROLOGY, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BJORN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-368-6876
Mailing Address - Street 1:1530 N 115TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8421
Mailing Address - Country:US
Mailing Address - Phone:206-368-6876
Mailing Address - Fax:206-368-9000
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8421
Practice Address - Country:US
Practice Address - Phone:206-368-6876
Practice Address - Fax:206-368-9000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1122233Medicaid
G8856594Medicare PIN
WA1122233Medicaid