Healthcare Provider Details

I. General information

NPI: 1558312819
Provider Name (Legal Business Name): SOUTHWEST INFECTIOUS DISEASES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16259 SYLVESTER RD SW SUITE 404
BURIEN WA
98166-3049
US

IV. Provider business mailing address

16259 SYLVESTER RD SW SUITE 404
BURIEN WA
98166-3049
US

V. Phone/Fax

Practice location:
  • Phone: 206-243-3049
  • Fax: 206-244-3991
Mailing address:
  • Phone: 206-243-3049
  • Fax: 206-244-3991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY K BERGER
Title or Position: MEDICAL BILLER
Credential: MD
Phone: 360-297-8805