Provider Demographics
NPI:1043260185
Name:PACIFIC NORTHWEST HEALTHCARE
Entity type:Organization
Organization Name:PACIFIC NORTHWEST HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:GARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-692-1848
Mailing Address - Street 1:10513 SILVERDALE WAY NW
Mailing Address - Street 2:STE 101
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9499
Mailing Address - Country:US
Mailing Address - Phone:360-692-1848
Mailing Address - Fax:360-692-1912
Practice Address - Street 1:10513 SILVERDALE WAY NW
Practice Address - Street 2:STE 101
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9499
Practice Address - Country:US
Practice Address - Phone:360-692-1848
Practice Address - Fax:360-692-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001303174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858907Medicare ID - Type Unspecified