Provider Demographics
NPI:1023168184
Name:CARDIAC HEALTH SPECIALISTS PS
Entity type:Organization
Organization Name:CARDIAC HEALTH SPECIALISTS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAED
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-927-1244
Mailing Address - Street 1:PO BOX 3797
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3797
Mailing Address - Country:US
Mailing Address - Phone:253-627-1244
Mailing Address - Fax:253-627-6576
Practice Address - Street 1:1802 YAKIMA AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4499
Practice Address - Country:US
Practice Address - Phone:253-627-1244
Practice Address - Fax:253-627-6576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0139458OtherDEPARTMENT OF L&I
WA7078710Medicaid
WACG6302OtherRAILROAD MEDICARE
WA7078710Medicaid