Provider Demographics
NPI: | 1457309312 |
---|---|
Name: | NORTHWEST NASAL SINUS CENTER |
Entity Type: | Organization |
Organization Name: | NORTHWEST NASAL SINUS CENTER |
Other - Org Name: | NORTHWEST FACE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ADMINISTRATOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ARLENE |
Authorized Official - Middle Name: | B |
Authorized Official - Last Name: | ALLEGRA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 425-576-1700 |
Mailing Address - Street 1: | 3100 CARILLON PT |
Mailing Address - Street 2: | |
Mailing Address - City: | KIRKLAND |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98033-7306 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 425-576-1700 |
Mailing Address - Fax: | 425-827-7725 |
Practice Address - Street 1: | 3100 CARILLON PT |
Practice Address - Street 2: | |
Practice Address - City: | KIRKLAND |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98033-7306 |
Practice Address - Country: | US |
Practice Address - Phone: | 425-576-1700 |
Practice Address - Fax: | 425-827-7725 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-04 |
Last Update Date: | 2012-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207YX0905X | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery | Group - Multi-Specialty |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207NS0135X | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology | Group - Multi-Specialty |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 207YS0123X | Allopathic & Osteopathic Physicians | Otolaryngology | Facial Plastic Surgery | Group - Multi-Specialty |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 231HA2400X | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Practitioner | Group - Multi-Specialty |
No | 231HA2500X | Speech, Language and Hearing Service Providers | Audiologist | Assistive Technology Supplier | Group - Multi-Specialty |
No | 237600000X | Speech, Language and Hearing Service Providers | Audiologist-Hearing Aid Fitter | Group - Multi-Specialty | |
No | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | Group - Multi-Specialty |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | G217111400 | Medicare PIN |