Provider Demographics
NPI:1902971351
Name:BELLINGHAM EAR NOSE THROAT AND FACIAL SURGERY INC
Entity Type:Organization
Organization Name:BELLINGHAM EAR NOSE THROAT AND FACIAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOOST
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNOPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-733-0640
Mailing Address - Street 1:2940 SQUALICUM PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1892
Mailing Address - Country:US
Mailing Address - Phone:360-733-0640
Mailing Address - Fax:360-733-1034
Practice Address - Street 1:2940 SQUALICUM PKWY
Practice Address - Street 2:STE 203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1892
Practice Address - Country:US
Practice Address - Phone:360-733-0640
Practice Address - Fax:360-733-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7106305Medicaid
WA7106305Medicaid