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General NPI Number Information
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NPI Number | 1316393036
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Entity Type | Organization
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Legal Business Name | HEALTH HEROES PNW, INC.
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Dates
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Enumeration Date | 05/12/2016
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Last Update Date | 05/12/2016
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Provider Practice Location Address
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Address Line | 720 S 320TH ST STE E
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5254
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Country | US
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Telephone | 206-419-1815
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Fax |
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Provider Business Mailing Address
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Address Line | 23418 PACIFIC HWY S PO BOX 3104
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City | KENT
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State | WA
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Zip | 98032-9994
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Country | US
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Telephone | 206-419-1815
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RANDY C SMITH JR.
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Credential |
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Telephone | 206-419-1815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 603-607-747
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 603-607-747
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License Number State | WA
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