MEDICARE: NORTHWEST KIDNEY CENTERS

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0251	OTHER	WA	REGENCE BLUE SHIELD
2	179	OTHER	WA	PREMERA BLUE CROSS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891880332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST KIDNEY CENTERS

Provider Business Mailing Address
First Line	:	12901 20TH AVE S
Second Line	:
City	:	SEATAC
State	:	WA
Zip	:	98168-5159
Country	:	US
Telephone Number	:	206-292-2771
Fax Number	:	206-860-5821

Provider Business Practice Location Address
First Line	:	707 S CHASE ST
Second Line	:
City	:	PORT ANGELES
State	:	WA
Zip	:	98362-6121
Country	:	US
Telephone Number	:	206-292-2771
Fax Number	:	206-860-5821

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	JENNIFER ESLAVA
Credential	:
Telephone Number	:	206-292-2771

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	04/04/2025

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Directions to “NORTHWEST KIDNEY CENTERS ” Practice Location

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