1528266103 NPI number — EVERETT CARDIOLOGY & ELECTROPHYSIOLOGY, P.S.

Table of content: (NPI 1528266103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528266103 NPI number — EVERETT CARDIOLOGY & ELECTROPHYSIOLOGY, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERETT CARDIOLOGY & ELECTROPHYSIOLOGY, P.S.
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:
1528266103
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1330 ROCKEFELLER AVE
Provider Second Line Business Mailing Address:
225
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-1684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-261-4910
Provider Business Mailing Address Fax Number:
425-261-4911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 ROCKEFELLER AVE
Provider Second Line Business Practice Location Address:
225
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-261-4910
Provider Business Practice Location Address Fax Number:
425-261-4911
Provider Enumeration Date:
07/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSE
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
STEVEN
Authorized Official Title or Position:
PHYSICIAN, PART OWNER
Authorized Official Telephone Number:
425-261-4910

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  MD00022810 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: PA10004886 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: MD00022810 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: PA10004886 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: MD00022810 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: PA10004886 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8435968 . This is a "DSHS J.MATISTA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1005040 . This is a "DSHS J. ROSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1396749701 . This is a "NPI, J.ROSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 363A00000X . This is a "TAXONOMY, J.MATISTA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1366435943 . This is a "NPI, J.MATISTA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 207RC0000X . This is a "TAXONOMY, J.ROSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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