Provider Demographics
NPI:1750401147
Name:NORTHWEST NASAL SINUS ASC
Entity type:Organization
Organization Name:NORTHWEST NASAL SINUS ASC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALLEGRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-576-1700
Mailing Address - Street 1:3100 CARILLON PT
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7306
Mailing Address - Country:US
Mailing Address - Phone:425-576-1700
Mailing Address - Fax:425-650-9925
Practice Address - Street 1:3100 CARILLON PT
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7306
Practice Address - Country:US
Practice Address - Phone:425-576-1700
Practice Address - Fax:425-650-9925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAFX00056152261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherFEDERAL TAX ID
WA=========OtherFEDERAL TAX ID
WA217000046Medicare PIN