NPIMap

Organization Active NPI

Northwest Vein and Aesthetic Center PS

  • Legal Medicine
  • Gig Harbor, WA
National Provider Identifier
1548409337
Registry record updated Feb 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Legal MedicineTaxonomy code 173000000X
License
MD00028685 Issued in WA
Legal business name
NORTHWEST VEIN AND AESTHETIC CENTER PS
Practice address
4700 Point Fosdick Dr NW Ste 307
Gig Harbor, WA 98335-1706
Phone
(253) 857-8346
Fax
(253) 857-0259
NPI assigned
Feb 18, 2009
Last updated
Feb 18, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2009

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

Authorized official

Name
Dr. Aksel G Nordestgaard, MDNPI 1083630602
Title
President
Phone
(253) 857-8346

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193400000X SINGLE SPECIALTY GROUP 173000000X MD00028685 WA Primary

Addresses

Primary practice location

4700 Point Fosdick Dr NW Ste 307
Gig Harbor, WA 98335-1706

Mailing address

4700 Point Fosdick Dr NW Ste 307
Gig Harbor, WA 98335-1706
Phone (253) 857-8346

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090313000219 WA Part B Supplier - Clinic/Group Practice 6608932884 Receives reassigned benefits from 3 practitioners
Practice locations: Sequim, WA; Tumwater, WA; Gig Harbor, WA

National Provider Directory

National Provider Directory

Locations

4700 Point Fosdick Dr
Ste 307
Gig Harbor, WA 98335
Phone (253) 857-8346

500 Lilly Rd NE
Ste 160
Olympia, WA 98506
Phone (360) 413-8307

528 N 5th Ave
Sequim, WA 98382
Phone (360) 339-8535

1610 Bishop Rd SW
Ste 101
Tumwater, WA 98512
Phone (360) 754-3338

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1234915200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234915200000",
    "number": "1548409337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR NW STE 307",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-857-8346",
            "fax_number": "253-857-0259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DR NW STE 307",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983351706",
            "telephone_number": "253-857-8346",
            "fax_number": "253-857-0259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST VEIN AND AESTHETIC CENTER PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-18",
        "last_updated": "2009-02-18",
        "status": "A",
        "authorized_official_last_name": "NORDESTGAARD",
        "authorized_official_first_name": "AKSEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-857-8346",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "WA",
            "license": "MD00028685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gig Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; 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.