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General NPI Number Information
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NPI Number | 1356827828
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Entity Type | Organization
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Legal Business Name | SEATTLE SPINE GROUP, PLLC
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Dates
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Enumeration Date | 07/17/2018
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 1220 116TH AVE NE STE 102
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City | BELLEVUE
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State | WA
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Zip | 98004
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Country | US
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Telephone | 425-454-0406
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Fax | 425-454-8225
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Provider Business Mailing Address
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Address Line | 1220 116TH AVE NE STE 102
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City | BELLEVUE
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State | WA
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Zip | 98004-3826
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Country | US
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Telephone | 425-454-0406
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | LUCY SEIPLE HOSTETTER
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Credential | MD
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Telephone | 425-454-0406
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD00040889
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD60174685
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License Number State | WA
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