Provider Demographics
NPI:1851514244
Name:NEUROSURGICAL CONSULTANTS OF WASHINGTON, INC P S
Entity type:Organization
Organization Name:NEUROSURGICAL CONSULTANTS OF WASHINGTON, INC P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-456-0922
Mailing Address - Street 1:1515 116TH AVE NE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3811
Mailing Address - Country:US
Mailing Address - Phone:425-456-0922
Mailing Address - Fax:425-688-1588
Practice Address - Street 1:1515 116TH AVE NE
Practice Address - Street 2:SUITE 302
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3811
Practice Address - Country:US
Practice Address - Phone:425-456-0922
Practice Address - Fax:425-688-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034595207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1043312648OtherNPI
WA8206716Medicaid
WAG44844Medicare UPIN
WA8857658Medicare ID - Type Unspecified