| |
16255 Ne 87th St Ste 150 Redmond WA 98052-7464 | |
(425) 882-1697 | |
(425) 885-4179 |
Full Name | |
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Speciality | Clinic/Center |
Location | 16255 Ne 87th St Ste 150, Redmond, Washington |
Authorized Official Name and Position | Margaret Pennetti (CREDENTIALING COORDINATOR) |
Authorized Official Contact | 4252030469 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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955 Powell Ave Sw Renton WA 98057-2908 Ph: (425) 277-1311 | 16255 Ne 87th St Ste 150 Redmond WA 98052-7464 Ph: (425) 882-1697 |
NPI Number | 1891795621 |
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Provider Enumeration Date | 07/22/2005 |
Last Update Date | 06/13/2024 |
Medicare PECOS PAC ID | 9335042886 |
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Medicare Enrollment ID | O20070830000847 |
Identifier | Type | State | Issuer |
---|---|---|---|
1891795621 | NPI | - | NPPES |
7033988 | Medicaid | WA | |
501846 | Other | WA | MEDICARE PART A |
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