Provider Demographics
NPI:1386869808
Name:HAWTHORNE HILLS INTERNAL MEDICINE PLLC
Entity type:Organization
Organization Name:HAWTHORNE HILLS INTERNAL MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-523-9195
Mailing Address - Street 1:4026 NE 55TH ST
Mailing Address - Street 2:STE F
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2262
Mailing Address - Country:US
Mailing Address - Phone:206-523-9195
Mailing Address - Fax:206-523-5399
Practice Address - Street 1:4026 NE 55TH ST
Practice Address - Street 2:STE F
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2262
Practice Address - Country:US
Practice Address - Phone:206-523-9195
Practice Address - Fax:206-523-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021170207R00000X
WAMD00020845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7096290Medicaid
WAAB08250Medicare PIN