Healthcare Provider Details

I. General information

NPI: 1306021456
Provider Name (Legal Business Name): AMERICAN MEDICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 154TH AVE NE # 4602
BELLEVUE WA
98007
US

IV. Provider business mailing address

15127 NE 24TH ST #235
REDMOND WA
98052
US

V. Phone/Fax

Practice location:
  • Phone: 425-644-7554
  • Fax:
Mailing address:
  • Phone: 425-644-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number601935160
License Number StateWA

VIII. Authorized Official

Name: ASAM MUSTAFA
Title or Position: CEO
Credential: MBA
Phone: 425-518-3642