1790882496 NPI number — RKSO LLC

Table of content: (NPI 1790882496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790882496 NPI number — RKSO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RKSO LLC
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:
MILL PLAIN MEDICAL
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:
1790882496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
416 NE 87TH AVE STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98664-1930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-253-4367
Provider Business Mailing Address Fax Number:
360-213-1602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 NE 87TH AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-1930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-253-4367
Provider Business Practice Location Address Fax Number:
360-213-1602
Provider Enumeration Date:
09/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
NICHOLE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-253-4367

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  CF00058058 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X , with the licence number: CF00058058 , 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: 9056516 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6023550 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".