Active NPI
Dynacare Northwest Inc
- Clinical Medical Laboratory
- Lynnwood, WA
National Provider Identifier
1275798407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- DYNACARE NORTHWEST INC
- Practice address
- 19401 40TH Ave W
Ste 100
Lynnwood, WA 98036-4612 - Phone
- (425) 744-7172
- NPI assigned
- Jul 28, 2008
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
19401 40TH Ave W
Ste 100
Lynnwood, WA 98036-4612
Mailing address
PO Box 2240
Burlington, NC 27216-2240
Phone (800) 222-7566
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50D0936416 | Other | CLIA |
Other names 1
- Pac Med Clinics Lynnwood
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 50D2198684 | Pacific Medical Centers - Lynnwood Clinic | Certificate of waiver | Apr 4, 2028 |
National Provider Directory
National Provider DirectoryLocations
19401 40th Ave W
Ste 100
Lynnwood, WA 98036
Phone (425) 309-0954
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": "1385424000000",
"number": "1275798407",
"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": "19401 40TH AVE W",
"address_2": "STE 100",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980364612",
"telephone_number": "425-744-7172"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DYNACARE NORTHWEST INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-07-28",
"last_updated": "2013-11-26",
"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": "50D0936416",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pac Med Clinics Lynnwood",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.