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NPI Code Detail

MEDICARE: HEALTHY LIFE PHYSICIANS GROUP PACIFIC NORTHWEST, P.C.

MEDICARE: HEALTHY LIFE PHYSICIANS GROUP PACIFIC NORTHWEST, P.C.
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
1207RE0101XEndocrinology, Diabetes & Metabolism Physician

General Provider Information

NPI Number : 1467271320
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHY LIFE PHYSICIANS GROUP PACIFIC NORTHWEST, P.C.
Provider Business Mailing Address
First Line : 109 STATE ST.
Second Line : 5TH FL
City : BOSTON
State : MA
Zip : 02109-2906
Country : US
Telephone Number : 617-505-1520
Fax Number : 617-928-8401
Provider Business Practice Location Address
First Line : 1455 NW LEARY WAY STE 400
Second Line :
City : SEATTLE
State : WA
Zip : 98107-5138
Country : US
Telephone Number : 617-505-1520
Fax Number : 617-928-8401
Authorized Official
Title or Position : PRESIDENT
Name : EMILY DAVIAU SMITH
Credential : MD
Telephone Number : 617-505-1520
Provider Enumeration Date : 10/08/2024
Last Update Date : 03/18/2026

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