Provider Demographics
NPI:1639448566
Name:BELLEVUE HEALTHCARE LLC
Entity type:Organization
Organization Name:BELLEVUE HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:GALLION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-274-8500
Mailing Address - Street 1:4500 PACIFIC AVE SE
Mailing Address - Street 2:STE B
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1112
Mailing Address - Country:US
Mailing Address - Phone:360-438-2955
Mailing Address - Fax:360-438-2112
Practice Address - Street 1:4500 PACIFIC AVE SE
Practice Address - Street 2:STE B
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1112
Practice Address - Country:US
Practice Address - Phone:360-438-2955
Practice Address - Fax:360-438-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA4788590007Medicare NSC