1265534713 NPI number — RAYMOND NEAL DOGGETT

Table of content: (NPI 1265534713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265534713 NPI number — RAYMOND NEAL DOGGETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAYMOND NEAL DOGGETT
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:
VALUPLUS HOME HEALTH CARE CENTER
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:
1265534713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1737 N WENATCHEE AVE STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801-1189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-663-8772
Provider Business Mailing Address Fax Number:
509-664-1820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1737 N WENATCHEE AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801-1189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-663-8772
Provider Business Practice Location Address Fax Number:
509-664-1820
Provider Enumeration Date:
09/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOGGETT
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PROPRIETOR/OWNER
Authorized Official Telephone Number:
509-663-8772

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9052317 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".