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NPI Code Detail

MEDICARE: DYNACARE NORTHWEST, INC

MEDICARE: DYNACARE NORTHWEST, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
250D1022467OTHERWACLIA

General Provider Information

NPI Number : 1902883861
Entity Type Code : Organization
Provider Name (Legal Business Name) : DYNACARE NORTHWEST, INC
Provider Business Mailing Address
First Line : PO BOX 2240
Second Line :
City : BURLINGTON
State : NC
Zip : 27216-2240
Country : US
Telephone Number : 800-222-7566
Fax Number : 336-436-1048
Provider Business Practice Location Address
First Line : 2450 33RD AVE W
Second Line : SUITE 100
City : SEATTLE
State : WA
Zip : 98199-3252
Country : US
Telephone Number : 206-320-5859
Fax Number :
Authorized Official
Title or Position : VP
Name : KIMBERLY T WILLIAMS
Credential :
Telephone Number : 800-222-7566
Provider Enumeration Date : 12/30/2005
Last Update Date : 11/04/2015

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Directions to “DYNACARE NORTHWEST, INC ” Practice Location

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