Provider Demographics
NPI:1316099724
Name:HOLISTIC HEALTH WEST
Entity type:Organization
Organization Name:HOLISTIC HEALTH WEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:206-932-0880
Mailing Address - Street 1:4744 41ST AVE SW STE 102
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4566
Mailing Address - Country:US
Mailing Address - Phone:206-932-0880
Mailing Address - Fax:206-932-3738
Practice Address - Street 1:4744 41ST AVE SW STE 102
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4566
Practice Address - Country:US
Practice Address - Phone:206-932-0880
Practice Address - Fax:206-932-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD3329261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD33296OtherBUSINESS LICENSE
WAG42888Medicare UPIN
WAMD33296OtherBUSINESS LICENSE