1013926617 NPI number — MURRAY A BEIGHTON

Table of content: (NPI 1013926617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013926617 NPI number — MURRAY A BEIGHTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MURRAY A BEIGHTON
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:
TWILIGHT YEARS GERIATRIC CARE
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:
1013926617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6307 147TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDMONDS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98026-3649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-742-7953
Provider Business Mailing Address Fax Number:
425-742-3683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 228TH ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOTHELL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98021-9799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-742-7953
Provider Business Practice Location Address Fax Number:
425-742-3683
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEIGHTON
Authorized Official First Name:
MURRAY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
SOLE PROPRIETOR SUPERVISING PHYSICI
Authorized Official Telephone Number:
425-742-7953

Provider Taxonomy Codes

  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0155926 . This is a "DEPT LABOR INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7110935 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CJ5535 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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