Organization
PUGET SOUND KIDNEY CENTERS
Active
Other names
PSKC Monroe
Organization subpart
No
Provider details
NPI number
Authorized official
HAROLD S KELLY (PRESIDENT AND CEO)
(425) 259-5195
Entity
Organization
Contact information
Practice address
18121 149TH STREET SE, MONROE, WA 98272
(425) 259-5195
Mailing address
1019 PACIFIC AVE, EVERETT, WA 98201-4148
(425) 259-5195
(425) 259-4860
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
600401431
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2039843
—
WA
01
—
50-2576
MEDICARE ID-TYPE UNSPECIFIED
WA
Enumeration date
04/29/2014
Last updated
02/04/2015
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