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General NPI Number Information
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NPI Number | 1043398407
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Entity Type | Organization
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Legal Business Name | OPTION 1 NORTHWEST ENTERAL LLC
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 8633 SOUTH 212TH STREET
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City | KENT
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State | WA
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Zip | 98031
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Country | US
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Telephone | 888-885-2386
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Fax | 888-599-3448
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Provider Business Mailing Address
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Address Line | 400 INTERSTATE NORTH PKWY SE STE 1600
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City | ATLANTA
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State | GA
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Zip | 30339-5047
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Country | US
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Telephone | 470-464-8000
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Fax | 770-248-8192
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Authorized Official
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Title or Position | CFO
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Name | MATTHEW BUCKHALTER
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Credential |
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Telephone | 470-464-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number |
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License Number State |
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