Athenix Physicians Group Northwest, PLLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

MD 60033065 Issued in WA

Legal business name

ATHENIX PHYSICIANS GROUP NORTHWEST, PLLC

Doing business as

Athenix Body Sculpting Institute

Practice address

636 120TH Ave NE Ste 202
Bellevue, WA 98005-3028

Phone

(425) 454-2410

Fax

(425) 454-2259

NPI assigned

Jul 16, 2014

Organization subpart

No

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

Authorized official

Name

Mr. James Haefner

Title

Administration

Phone

(949) 600-9931

Specialties & licenses 1

Addresses

Other names 1

• Athenix Body Sculpting Institute Doing business as

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

{
    "created_epoch": "1405468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405468800000",
    "number": "1801203310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 120TH AVE NE STE 202",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980053028",
            "telephone_number": "425-454-2410",
            "fax_number": "425-454-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "636 120TH AVE NE STE 202",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980053028",
            "telephone_number": "425-454-2410",
            "fax_number": "425-454-2259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHENIX PHYSICIANS GROUP NORTHWEST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-16",
        "last_updated": "2014-07-16",
        "status": "A",
        "authorized_official_last_name": "HAEFNER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "949-600-9931",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "WA",
            "license": "MD 60033065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Athenix Body Sculpting Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Plastic and Reconstructive Surgery Physician in Bellevue, WA
• Providers in Bellevue, WA by specialty
• Plastic and Reconstructive Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.