Provider Demographics
NPI:1053184861
Name:PREMISE HEALTH OF WASHINGTON MEDICAL, PC
Entity type:Organization
Organization Name:PREMISE HEALTH OF WASHINGTON MEDICAL, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:WILL
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-577-5893
Mailing Address - Street 1:5500 MARYLAND WAY
Mailing Address - Street 2:STE 120
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027
Mailing Address - Country:US
Mailing Address - Phone:615-468-6242
Mailing Address - Fax:615-468-6242
Practice Address - Street 1:747 6TH ST S
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6715
Practice Address - Country:US
Practice Address - Phone:425-400-3245
Practice Address - Fax:425-952-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-02
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty