Provider Demographics
NPI:1750427738
Name:TED BURRIS & ASSOCIATES
Entity type:Organization
Organization Name:TED BURRIS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-392-3920
Mailing Address - Street 1:4637 227TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7248
Mailing Address - Country:US
Mailing Address - Phone:425-392-3920
Mailing Address - Fax:425-392-4705
Practice Address - Street 1:4637 227TH PL SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7248
Practice Address - Country:US
Practice Address - Phone:425-392-3920
Practice Address - Fax:425-392-4705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9038415Medicaid
WA64069OtherL&I
WABU2241OtherWA BLUE SHIELD