NPIMap

Organization Active NPI

Dynacare Northwest Inc.

Doing business as Issaquah Stat Lab

  • Clinical Medical Laboratory
  • Issaquah, WA
National Provider Identifier
1033374236
Registry record updated Dec 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
DYNACARE NORTHWEST INC.
Doing business as
Issaquah Stat Lab
Practice address
450 NW Gilman Blvd Ste 101
Issaquah, WA 98027-2483
Phone
(425) 391-0752
NPI assigned
Jul 28, 2008
Last updated
Dec 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kimberly Williams
Title
VP
Phone
(800) 222-7566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

450 NW Gilman Blvd Ste 101
Issaquah, WA 98027-2483

Mailing address

PO Box 2240
Burlington, NC 27216-2240
Phone (800) 222-7566

Other identifiers 1

IdentifierTypeStateIssuer
50D1017881OtherCLIA

Other names 1

  • Issaquah Stat Lab Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040217000665 WA Part B Supplier - Independent Clinical Laboratory 5597650788 28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Issaquah, WA; Redmond, WA; Seattle, WA

Other NPIs on the same Medicare enrollment 27

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 27

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387756800000",
    "number": "1033374236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2240",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272162240",
            "telephone_number": "800-222-7566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 NW GILMAN BLVD STE 101",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980272483",
            "telephone_number": "425-391-0752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNACARE NORTHWEST INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-28",
        "last_updated": "2013-12-23",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "800-222-7566"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "50D1017881",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Issaquah Stat Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.