=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083007769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COSTCO WHOLESALE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2015
-----------------------------------------------------
Last Update Date | 03/05/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15255 N HAYDEN RD
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-2551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-609-1420
-----------------------------------------------------
Fax | 480-609-1457
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 35005
-----------------------------------------------------
City | SEATTLE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98124-3405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-313-8100
-----------------------------------------------------
Fax | 425-313-6922
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CHRISTIAN ANTHIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 425-427-3530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332S00000X
-----------------------------------------------------
Taxonomy Name | Hearing Aid Equipment
-----------------------------------------------------
License Number | BHAD6201
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------