1588658124 NPI number — KIRK JARMAN P.A.

Table of content: KIRK JARMAN P.A. (NPI 1588658124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588658124 NPI number — KIRK JARMAN P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JARMAN
Provider First Name:
KIRK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
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:
1588658124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98507-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-491-8439
Provider Business Mailing Address Fax Number:
360-491-6328

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1625 MOTTMAN RD SW
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
TUMWATER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98512-7833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-528-2822
Provider Business Practice Location Address Fax Number:
360-528-2830
Provider Enumeration Date:
09/09/2005

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: 363AM0700X , with the licence number:  PA16431 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA10004277 , 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: 8466252 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".