Provider Demographics
NPI:1245675719
Name:COLWELL, STEVEN G (CPO BOCO LPO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:COLWELL
Suffix:
Gender:M
Credentials:CPO BOCO LPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 NE 181ST ST
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-4801
Mailing Address - Country:US
Mailing Address - Phone:206-440-1811
Mailing Address - Fax:425-488-3025
Practice Address - Street 1:6509 NE 181ST ST
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-4801
Practice Address - Country:US
Practice Address - Phone:206-440-1811
Practice Address - Fax:425-488-3025
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00000160174400000X
WA000001611744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4533580001Medicare NSC