| Healthy Life Physicians Group Pacific Northwest, P.c. | |
|
1455 Nw Leary Way Ste 400 Seattle WA 98107-5138 | |
| (617) 505-1520 | |
| Not Available |
| Full Name | Healthy Life Physicians Group Pacific Northwest, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 1455 Nw Leary Way Ste 400, Seattle, Washington |
| Authorized Official Name and Position | Emily Smith (PRESIDENT) |
| Authorized Official Contact | 6175051520 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthy Life Physicians Group Pacific Northwest, P.c. 179 Lincoln St Ste 404 Boston MA 02111-2425 Ph: (617) 505-1520 | Healthy Life Physicians Group Pacific Northwest, P.c. 1455 Nw Leary Way Ste 400 Seattle WA 98107-5138 Ph: (617) 505-1520 |
| NPI Number | 1558010132 |
|---|---|
| Provider Enumeration Date | 03/22/2022 |
| Last Update Date | 06/01/2022 |
| Medicare PECOS PAC ID | 3476938069 |
|---|---|
| Medicare Enrollment ID | O20220919000474 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558010132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | (* (Not Available)) | Secondary |
| Provider Name | Kirsten Frederiksen |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1518057314 PECOS PAC ID: 5799760633 Enrollment ID: I20170207002108 |
| Provider Name | Emily Daviau Smith |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1386906089 PECOS PAC ID: 6406151554 Enrollment ID: I20220919000597 |
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