1336263649 NPI number — NORTHWEST PULMONOLOGY PHYSICIANS PC

Table of content: (NPI 1336263649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336263649 NPI number — NORTHWEST PULMONOLOGY PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST PULMONOLOGY PHYSICIANS PC
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:
1336263649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 635704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-5704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-562-2945
Provider Business Mailing Address Fax Number:
253-838-6418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21601 76TH AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDMONDS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98026-7507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-364-2050
Provider Business Practice Location Address Fax Number:
206-361-5722
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RICE
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SR VP & CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
800-336-8614

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , 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: 7137912 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1055NO . This is a "BCBS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0220093 . This is a "LABOR & IND STEVENS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0220096 . This is a "LABOR & IND WA KINDRED" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7139140 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8945381 . This is a "VCR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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