Healthcare Provider Details

I. General information

NPI: 1356827828
Provider Name (Legal Business Name): SEATTLE SPINE GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 116TH AVE NE STE 102
BELLEVUE WA
98004
US

IV. Provider business mailing address

1220 116TH AVE NE STE 102
BELLEVUE WA
98004-3826
US

V. Phone/Fax

Practice location:
  • Phone: 425-454-0406
  • Fax: 425-454-8225
Mailing address:
  • Phone: 425-454-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60174685
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00040889
License Number StateWA

VIII. Authorized Official

Name: LUCY SEIPLE HOSTETTER
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 425-454-0406