MEDICARE: PACIFIC NORTHWEST MEDICAL SERVICES PLLC

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	261QM1300X	Multi-Specialty Clinic/Center
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1629466917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC NORTHWEST MEDICAL SERVICES PLLC

Provider Business Mailing Address
First Line	:	18012 W VALLEY HWY
Second Line	:	SUITE 101
City	:	KENT
State	:	WA
Zip	:	98032-2924
Country	:	US
Telephone Number	:	425-291-3300
Fax Number	:	425-291-5300

Provider Business Practice Location Address
First Line	:	116 FAIRVIEW AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-5360
Country	:	US
Telephone Number	:	206-718-0742
Fax Number	:	253-813-3686

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	ANDREW T LE
Credential	:	MD
Telephone Number	:	425-291-3300

Provider Enumeration Date	:	01/08/2015
Last Update Date	:	06/19/2019

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