1396848412 NPI number — MR. ELI NATHANIEL LAMBERT PT

Table of content: MR. ELI NATHANIEL LAMBERT PT (NPI 1396848412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396848412 NPI number — MR. ELI NATHANIEL LAMBERT PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAMBERT
Provider First Name:
ELI
Provider Middle Name:
NATHANIEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

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:
1396848412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3606 NE 54TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-302-8000
Provider Business Mailing Address Fax Number:
509-302-8000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1499 SE TECH CENTER PL STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98683-9575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-859-4886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00008627 , 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: 8444184 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".