EASTSIDE MEDICAL GROUP LLC NPI 1750709358

NPI Information

NPI: 1750709358
Provider Name: EASTSIDE MEDICAL GROUP, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 50D2078838

Address:
1301 4TH AVE NW
ISSAQUAH, WA
ZIP 98027
Phone: (425) 270-3713
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EASTSIDE MEDICAL GROUP, LLC is an ambulatory surgical clinic center in Issaquah, WA. EASTSIDE MEDICAL GROUP, LLC NPI is 1750709358. The provider is registered as an organization entity type.

The provider's business location address is:

1301 4TH AVE NW
ISSAQUAH, WA
ZIP 98027-371
Phone: (425) 270-3713
Fax: (425) 295-7557

The provider's authorized official is Robert Howie .
The authorized official title is Treasurer and has the following contact phone number (425) 837-9720.

The CLIA number assigned to this NPI record is 50D2078838 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/1/2014 and was last updated on 1/18/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes
2	261QM1300X	Clinic/Center	Multi-Specialty			No

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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