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General NPI Number Information
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NPI Number | 1528478609
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Entity Type | Organization
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Legal Business Name | PUGET SOUND KIDNEY CENTERS
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Dates
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Enumeration Date | 04/29/2014
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 18121 149TH STREET SE
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City | MONROE
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State | WA
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Zip | 98272
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Country | US
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Telephone | 425-259-5195
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Fax |
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Provider Business Mailing Address
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Address Line | 1019 PACIFIC AVE
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City | EVERETT
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State | WA
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Zip | 98201-4148
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Country | US
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Telephone | 425-259-5195
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Fax | 425-259-4860
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | HAROLD S KELLY
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Credential |
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Telephone | 425-259-5195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 600401431
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License Number State | WA
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