Provider Demographics
NPI:1043583586
Name:STEVEN J ANDERSON MD INC PS
Entity type:Organization
Organization Name:STEVEN J ANDERSON MD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-523-1422
Mailing Address - Street 1:3216 NE 45TH PL
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4093
Mailing Address - Country:US
Mailing Address - Phone:206-523-1422
Mailing Address - Fax:206-523-3101
Practice Address - Street 1:3216 NE 45TH PL
Practice Address - Street 2:SUITE 304
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4093
Practice Address - Country:US
Practice Address - Phone:206-523-1422
Practice Address - Fax:206-523-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00021245261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06026Medicare UPIN