1346267796 NPI number — OLYMPIA EMERGENCY SERVICES, PLLC

Table of content: (NPI 1346267796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346267796 NPI number — OLYMPIA EMERGENCY SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIA EMERGENCY SERVICES, PLLC
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:
1346267796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5007
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LACEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98509-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-918-0119
Provider Business Mailing Address Fax Number:
360-413-0035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
413 LILLY RD NE
Provider Second Line Business Practice Location Address:
MAILSTOP DDH09
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98506-5133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-491-9480
Provider Business Practice Location Address Fax Number:
360-493-5746
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-493-4554

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 533663001 . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0153352 . This is a "WA L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CJ3476 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1659OL . This is a "PREMERA BC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 268740 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50D0998652 . This is a "CLAI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7109192 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8935574 . This is a "WA CRIME VICITMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 192906100 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".




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