Provider Demographics
NPI:1215239595
Name:NES WASHINGTON, INC.
Entity type:Organization
Organization Name:NES WASHINGTON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-557-6183
Mailing Address - Street 1:7300 STATE HIGHWAY 121 STE 370-374
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1987
Mailing Address - Country:US
Mailing Address - Phone:469-557-6183
Mailing Address - Fax:469-640-6671
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-225-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DR7134OtherRR MEDICARE
AK1571009Medicaid
AK1571009Medicaid