Healthcare Provider Details

I. General information

NPI: 1952659393
Provider Name (Legal Business Name): NORTHWEST PHYSICIANS LABORATORIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 NORTHUP WAY SUITE 100
BELLEVUE WA
98004-1464
US

IV. Provider business mailing address

2800 NORTHUP WAY SUITE 120
BELLEVUE WA
98004-1440
US

V. Phone/Fax

Practice location:
  • Phone: 425-563-6263
  • Fax: 425-642-8078
Mailing address:
  • Phone: 425-563-6263
  • Fax: 425-642-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number50D2040375
License Number StateWA

VIII. Authorized Official

Name: MR. JAE LEE
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 425-563-6263