1013040500 NPI number — EMERGENCY ROOMS, PS

Table of content: (NPI 1013040500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013040500 NPI number — EMERGENCY ROOMS, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERGENCY ROOMS, PS
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:
FAMILY CARE & URGENT MEDICAL
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:
1013040500
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4421 NE ST JOHNS RD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661-2573
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-695-9922
Provider Business Mailing Address Fax Number:
360-695-1310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4421 NE ST JOHNS RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661-2573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-695-9922
Provider Business Practice Location Address Fax Number:
360-695-1310
Provider Enumeration Date:
03/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BIGONI
Authorized Official First Name:
LEANN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OPERATIONS
Authorized Official Telephone Number:
360-695-9922

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0829670001 . This is a "MEDICARE TYPE UNSPECIFIED" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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