Healthcare Provider Details

I. General information

NPI: 1154496537
Provider Name (Legal Business Name): NORTHWEST ASTHMA & ALLERGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 COLUMBIA POINT DR
RICHLAND WA
99352-4387
US

IV. Provider business mailing address

4540 SAND POINT WAY NE SUITE 200
SEATTLE WA
98105-3941
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-0189
  • Fax: 509-946-0264
Mailing address:
  • Phone: 206-527-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA S MATHIAS
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 206-527-2577