1043403702 NPI number — PHYSICIANS ANESTHESIA OF MONROE

Table of content: (NPI 1043403702)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043403702 NPI number — PHYSICIANS ANESTHESIA OF MONROE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS ANESTHESIA OF MONROE
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:
Provider Other Organization Name Type Code:
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:
1043403702
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2990
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98213-0990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-353-3788
Provider Business Mailing Address Fax Number:
425-353-8041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 S STILLAGUAMISH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98223-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-435-2133
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
REED
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CREDENTIALING
Authorized Official Telephone Number:
425-353-3788

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  AP30007199 , 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)