Basic Information
Provider Information
NPI: 1194758250
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUEMMER
FirstName: THOMAS
MiddleName: M
NamePrefix: MR.
NameSuffix:  
Credential: PAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 805 MADISON ST
Address2: SUITE 901
City: SEATTLE
State: WA
PostalCode: 981041172
CountryCode: US
TelephoneNumber: 2062648100
FaxNumber: 2062648689
Practice Location
Address1: 601 BROADWAY
Address2:  
City: SEATTLE
State: WA
PostalCode: 981225330
CountryCode: US
TelephoneNumber: 2063862600
FaxNumber: 2066221644
Other Information
ProviderEnumerationDate: 07/09/2006
LastUpdateDate: 10/10/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AS0400XPA10002204WAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical

No ID Information.


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