1588616080 NPI number — DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON PC

Table of content: (NPI 1588616080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588616080 NPI number — DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON 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:
DAVITA NEPHROLOGY PARTNERS
Provider Other Organization Name Type Code:
3
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:
1588616080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60000 FILE #74521
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94160-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-626-6234
Provider Business Mailing Address Fax Number:
866-302-6807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16233 SYLVESTER RD SW
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-935-5423
Provider Business Practice Location Address Fax Number:
206-935-5469
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GABRIEL
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
EFTHIM
Authorized Official Title or Position:
OWNER PRESIDENT SECRETARY & TREASUR
Authorized Official Telephone Number:
800-310-4872

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346276797 . This is a "RICHLAND NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7126378 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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