Provider Demographics
NPI:1750754883
Name:BELLEVUE MEDICAL CENTER
Entity type:Organization
Organization Name:BELLEVUE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAYMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KOONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-577-1517
Mailing Address - Street 1:10655 NE 4TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5035
Mailing Address - Country:US
Mailing Address - Phone:425-577-1517
Mailing Address - Fax:425-454-7767
Practice Address - Street 1:10655 NE 4TH ST
Practice Address - Street 2:STE 101
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5035
Practice Address - Country:US
Practice Address - Phone:425-577-1517
Practice Address - Fax:425-454-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004437363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty