Provider Demographics
NPI:1124084983
Name:UROLOGY NORTHWEST, PS
Entity type:Organization
Organization Name:UROLOGY NORTHWEST, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-275-5547
Mailing Address - Street 1:6005 244TH ST SW
Mailing Address - Street 2:STE 111
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5400
Mailing Address - Country:US
Mailing Address - Phone:425-275-5555
Mailing Address - Fax:425-275-5591
Practice Address - Street 1:6005 244TH ST SW
Practice Address - Street 2:STE 111
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5400
Practice Address - Country:US
Practice Address - Phone:425-275-5555
Practice Address - Fax:425-275-5591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WANO3976OtherKING COUNTY
WA7081094Medicaid
WACE8230OtherRAILROAD MEDICARE
WA105065OtherLABOR AND INDUSTRIES
WACE8230OtherRAILROAD MEDICARE