1770786493 NPI number — ADVANCED SPINAL CARE, INC

Table of content: (NPI 1770786493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770786493 NPI number — ADVANCED SPINAL CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SPINAL CARE, INC
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:
1770786493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21806 103RD AVENUE CT E
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
GRAHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98338-8115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-445-8181
Provider Business Mailing Address Fax Number:
253-445-7938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21806 103RD AVENUE CT E
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GRAHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98338-8115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-445-8181
Provider Business Practice Location Address Fax Number:
253-445-7938
Provider Enumeration Date:
06/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAPENSKI
Authorized Official First Name:
CLAIRE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
360-879-5673

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH00003689 , 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: 0160371 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".