MEDICARE: HOLISTIC HEALTH WEST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	MD3329	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD33296	OTHER	WA	BUSINESS LICENSE

General Provider Information

NPI Number	:	1316099724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLISTIC HEALTH WEST

Provider Business Mailing Address
First Line	:	4744 41ST AVE SW STE 102
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4566
Country	:	US
Telephone Number	:	206-932-0880
Fax Number	:	206-932-3738

Provider Business Practice Location Address
First Line	:	4744 41ST AVE SW STE 102
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4566
Country	:	US
Telephone Number	:	206-932-0880
Fax Number	:	206-932-3738

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARTIN PAUL ROSS I
Credential	:	M.D.
Telephone Number	:	206-932-0880

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/22/2020

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Directions to “HOLISTIC HEALTH WEST ” Practice Location

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