# EASTSIDE MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750709358
- **Authorized official:** ROBERT HOWIE (TREASURER)
- **Authorized official phone:** (425) 837-9720

## Contact information

- **Practice address:** 1301 4TH AVE NW, ISSAQUAH, WA 98027-9371
- **Practice address phone:** (425) 270-3713
- **Practice address fax:** (425) 295-7557
- **Mailing address:** 1301 4TH AVE NW, SUITE 201, ISSAQUAH, WA 98027-9371
- **Mailing address phone:** (425) 270-3713
- **Mailing address fax:** (425) 295-7557

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/01/2014
- **Last updated:** 01/18/2017