1265505945 NPI number — PEDIATRIC ASSOCIATES, INC., P.S. DBA ALLEGRO PEDIATRICS

Table of content: (NPI 1265505945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265505945 NPI number — PEDIATRIC ASSOCIATES, INC., P.S. DBA ALLEGRO PEDIATRICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC ASSOCIATES, INC., P.S. DBA ALLEGRO PEDIATRICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
REDMOND
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265505945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2475 140TH AVE. NE, BUILDING C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-460-5601
Provider Business Mailing Address Fax Number:
425-460-5606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7530 164TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE A215
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-885-9292
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VANDENBERG
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
425-460-5643

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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