Provider Demographics
NPI:1144474198
Name:MAQSOOD BHATTI MD PS
Entity type:Organization
Organization Name:MAQSOOD BHATTI MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MAQSOOD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BHATTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-533-1243
Mailing Address - Street 1:1220 BASICH BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1070
Mailing Address - Country:US
Mailing Address - Phone:360-533-1243
Mailing Address - Fax:360-533-8333
Practice Address - Street 1:1220 BASICH BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1034
Practice Address - Country:US
Practice Address - Phone:360-533-1243
Practice Address - Fax:360-533-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00045781261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8469710Medicaid
WAI64380Medicare UPIN
WA8469710Medicaid