1063622462 NPI number — NATE SCURICH L.M.T.

Table of content: NATE SCURICH L.M.T. (NPI 1063622462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063622462 NPI number — NATE SCURICH L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCURICH
Provider First Name:
NATE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCURICH
Provider Other First Name:
NATHANIEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.T.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063622462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1425 BROADWAY
Provider Second Line Business Mailing Address:
25
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98122-3854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-226-2588
Provider Business Mailing Address Fax Number:
206-860-6092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3221 EASTLAKE AVE E
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98102-7125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-226-2588
Provider Business Practice Location Address Fax Number:
206-860-6092
Provider Enumeration Date:
05/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MA00009837 , 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)