1003099011 NPI number — HARBOR HEALING ARTS PLLC

Table of content: (NPI 1003099011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003099011 NPI number — HARBOR HEALING ARTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARBOR HEALING ARTS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HABOR HEALING ARTS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003099011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUNA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98395-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-851-3311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13214 150TH STREET KP N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIG HARBOR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98329-4668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-851-3311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HALLAWELL
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-851-3311

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  34020 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G8879872 . This is a "MEDICARE PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".