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General NPI Number Information
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NPI Number | 1265716799
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Entity Type | Organization
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Legal Business Name | HEALTHMAX INCORPORATED
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 10/03/2011
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Provider Practice Location Address
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Address Line | 320 106TH AVE NE SUITE A
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City | BELLEVUE
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State | WA
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Zip | 98004-5791
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Country | US
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Telephone | 206-362-1111
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Fax | 425-254-1111
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Provider Business Mailing Address
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Address Line | 320 106TH AVE NE SUITE A
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City | BELLEVUE
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State | WA
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Zip | 98004-5791
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Country | US
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Telephone | 206-362-1111
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Fax | 425-254-1111
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Authorized Official
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Title or Position | CHAIRMAN & CEO
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Name | DR. VERNON SCOTT CHEREWATENKO
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Credential | M.D.
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Telephone | 206-362-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25608
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License Number State | WA
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