| |
11027 Meridian Ave N Suite 100 Seattle WA 98133-1705 | |
(206) 365-4492 | |
(206) 368-3456 |
Full Name | |
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Speciality | Internal Medicine - Gastroenterology |
Location | 11027 Meridian Ave N, Seattle, Washington |
Authorized Official Name and Position | Eugenio J Hernandez (MANAGER) |
Authorized Official Contact | 7862053464 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 34888 Seattle WA 98124-1888 Ph: (425) 977-4620 | 11027 Meridian Ave N Suite 100 Seattle WA 98133-1705 Ph: (206) 365-4492 |
NPI Number | 1649212606 |
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Provider Enumeration Date | 06/12/2006 |
Last Update Date | 12/12/2019 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649212606 | NPI | - | NPPES |
1045049 | Medicaid | WA | |
0031330 | Other | WA | LABOR AND INDUSTRIES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207RG0100X | Internal Medicine - Gastroenterology | (Washington) | Primary |
291U00000X | Clinical Medical Laboratory | 600388519 (Washington) | Secondary |
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