Basic Information
| Provider Information | |||||||||
| NPI: | 1114937919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH SOUND EMERGENCY MEDICINE PC | ||||||||
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| OtherOrganizationName: | EMERGENCY PHYSICIANS MEDICAL GROUP NORTHWEST PC | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1716 W MARINE VIEW DR STE C | ||||||||
| Address2: | SUITE A11 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982012098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252590212 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1321 COLBY AVE | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252612000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2006 | ||||||||
| LastUpdateDate: | 03/19/2015 | ||||||||
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| AuthorizedOfficialLastName: | BARRY | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4252590212 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | 7094634 | 05 | WA | MEDICAID |