1689648594 NPI number — DR. PATRICIA M MCILVAINE M.D.

Table of content: DR. PATRICIA M MCILVAINE M.D. (NPI 1689648594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689648594 NPI number — DR. PATRICIA M MCILVAINE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCILVAINE
Provider First Name:
PATRICIA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1689648594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 W TIETAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLA WALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99362-4445
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-525-3720
Provider Business Mailing Address Fax Number:
509-522-1592

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 W TIETAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-4445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-3720
Provider Business Practice Location Address Fax Number:
509-522-1588
Provider Enumeration Date:
02/15/2006

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: 207R00000X , with the licence number:  MD00040784 , 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: 157704 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 268965 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8296022 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".