Provider Demographics
NPI:1457411811
Name:PLASTIC SURGERY SEATTLE, PS
Entity Type:Organization
Organization Name:PLASTIC SURGERY SEATTLE, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT CARE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-320-2270
Mailing Address - Street 1:1600 E JEFFERSON ST
Mailing Address - Street 2:#501
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5698
Mailing Address - Country:US
Mailing Address - Phone:206-320-2270
Mailing Address - Fax:206-320-2101
Practice Address - Street 1:1600 E JEFFERSON ST
Practice Address - Street 2:#510
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5698
Practice Address - Country:US
Practice Address - Phone:206-320-2270
Practice Address - Fax:206-320-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty