Healthcare Provider Details

I. General information

NPI: 1871672808
Provider Name (Legal Business Name): NORTHWEST NEWBORN AND PEDIATRIC SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S 43RD ST
RENTON WA
98055-5714
US

IV. Provider business mailing address

PO BOX 430
AUBURN WA
98071-0430
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5525
  • Fax: 425-656-4228
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. LOUIS D POLLACK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 425-656-5525