Provider Demographics
NPI:1427321405
Name:VASCULAR & SURGICAL CARE NORTHWEST, PLLC
Entity type:Organization
Organization Name:VASCULAR & SURGICAL CARE NORTHWEST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ARENDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-420-3119
Mailing Address - Street 1:PO BOX 22152
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-0152
Mailing Address - Country:US
Mailing Address - Phone:206-420-3119
Mailing Address - Fax:206-453-5912
Practice Address - Street 1:515 MINOR AVE STE 240
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2133
Practice Address - Country:US
Practice Address - Phone:206-420-3119
Practice Address - Fax:206-453-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208600000X, 2086S0129X
WAMD00043254246XC2903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No246XC2903XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularVascular SpecialistGroup - Multi-Specialty