Provider Demographics
NPI:1114189743
Name:PUGET SOUND HEARING AND BALANCE
Entity type:Organization
Organization Name:PUGET SOUND HEARING AND BALANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTHALONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-204-6958
Mailing Address - Street 1:PO BOX 59325
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-2325
Mailing Address - Country:US
Mailing Address - Phone:425-204-6958
Mailing Address - Fax:206-523-5882
Practice Address - Street 1:9714 3RD AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SEATTLE
Practice Address - State:USA
Practice Address - Zip Code:98115
Practice Address - Country:UM
Practice Address - Phone:206-523-5584
Practice Address - Fax:206-523-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD27287207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1108562Medicaid
GAB10778Medicare PIN
WA1108562Medicaid