1033347422 NPI number — BYWATER MEDICAL CONSULTANTS PLLC

Table of content: (NPI 1033347422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033347422 NPI number — BYWATER MEDICAL CONSULTANTS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BYWATER MEDICAL CONSULTANTS PLLC
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:
BYWATER PSYCHIATRIC CONSULTATION
Provider Other Organization Name Type Code:
4
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:
1033347422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1627
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT VERNON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98273-1627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-708-9741
Provider Business Mailing Address Fax Number:
801-780-9741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 E DIVISION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98274-6703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-708-9741
Provider Business Practice Location Address Fax Number:
360-588-4192
Provider Enumeration Date:
06/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-708-9741

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP30007181 , 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)





Copyright © 2007-2024 www.npivalidator.com