1093078412 NPI number — OLYMPIA HEALTH CARE SERVICES

Table of content: (NPI 1093078412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093078412 NPI number — OLYMPIA HEALTH CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIA HEALTH CARE SERVICES
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:
1093078412
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2415 PACIFIC AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-2065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-943-4644
Provider Business Mailing Address Fax Number:
360-943-2534

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2415 PACIFIC AVE SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98501-2065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-943-4644
Provider Business Practice Location Address Fax Number:
360-943-2534
Provider Enumeration Date:
06/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
360-943-4644

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DE00007112 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 122300000X , with the licence number: DE00006203 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: DE60016751 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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