Provider Demographics
NPI:1235206558
Name:BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC
Entity type:Organization
Organization Name:BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-637-1022
Mailing Address - Street 1:PO BOX 31001-1839
Mailing Address - Street 2:BELLEVUE INTERNAL MEDICINE ASSOCIATES PLLC
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-1839
Mailing Address - Country:US
Mailing Address - Phone:425-637-1022
Mailing Address - Fax:425-637-2011
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:SUITE A101 & A102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3782
Practice Address - Country:US
Practice Address - Phone:425-637-1022
Practice Address - Fax:425-637-2011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024795207RG0300X
WA601913899207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7093594Medicaid
WA7093594Medicaid