1982805784 NPI number — PROVIDENCE EVERETT MEDICAL CENTER

Table of content: (NPI 1982805784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982805784 NPI number — PROVIDENCE EVERETT MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROVIDENCE EVERETT MEDICAL CENTER
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:
PEMC FAMILY RESOURCE CENTER
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:
1982805784
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 N BROADWAY
Provider Second Line Business Mailing Address:
PBO/CREDENTIALING
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201-1409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-317-0264
Provider Business Mailing Address Fax Number:
425-317-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 PACIFIC AVE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-4168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-304-6000
Provider Business Practice Location Address Fax Number:
425-304-6048
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KOBAYASHI
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIR REVENUE CYCLE MGMT NWSA
Authorized Official Telephone Number:
425-317-0186

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , 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: 9044397 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7407125 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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