1487766457 NPI number — BENJAMIN E SIAPCO CRNA

Table of content: BENJAMIN E SIAPCO CRNA (NPI 1487766457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487766457 NPI number — BENJAMIN E SIAPCO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIAPCO
Provider First Name:
BENJAMIN
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1487766457
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98497-0115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-588-7911
Provider Business Mailing Address Fax Number:
253-984-6774

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 LITTLE MOUNTAIN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98274-8752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-416-6735
Provider Business Practice Location Address Fax Number:
360-424-6924
Provider Enumeration Date:
08/31/2006

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: 367500000X , with the licence number:  RN00156113 , 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: 0228823 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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