Basic Information
| Provider Information | |||||||||
| NPI: | 1104098706 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOEL HIGHNESS MD PS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5908 | ||||||||
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| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980060408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062441212 | ||||||||
| FaxNumber: | 8667639815 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 17TH AVE | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981225711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062441212 | ||||||||
| FaxNumber: | 8667639815 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2008 | ||||||||
| LastUpdateDate: | 07/11/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | SUSAN | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2062441212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD00015221 | WA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1117233 | 05 | WA | MEDICAID |