Provider Demographics
NPI:1457565459
Name:NORTHWEST ASTHMA & ALLERGY CENTER
Entity Type:Organization
Organization Name:NORTHWEST ASTHMA & ALLERGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MATHIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-527-2577
Mailing Address - Street 1:4540 SAND POINT WAY NE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3941
Mailing Address - Country:US
Mailing Address - Phone:206-527-1200
Mailing Address - Fax:206-523-0724
Practice Address - Street 1:1412 SW 43RD ST
Practice Address - Street 2:SUITE 210
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-4803
Practice Address - Country:US
Practice Address - Phone:425-235-1716
Practice Address - Fax:425-277-5479
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST ASTHMA & ALLERGY CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP7653OtherRAILROAD MEDICARE
WACP7653OtherRAILROAD MEDICARE