1083885651 NPI number — RICHARDSON BAY PHYSICIANS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083885651 NPI number — RICHARDSON BAY PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARDSON BAY PHYSICIANS
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:
Provider Other Organization Name Type Code:
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:
1083885651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 5TH AVE
Provider Second Line Business Mailing Address:
SUITE 830
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98101-3621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-624-6050
Provider Business Mailing Address Fax Number:
206-623-7674

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 CASTRO ST
Provider Second Line Business Practice Location Address:
120-426
Provider Business Practice Location Address City Name:
MOUNTAIN VIEW
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94041-2055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-417-1157
Provider Business Practice Location Address Fax Number:
206-623-7674
Provider Enumeration Date:
03/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL OPERATIONS ASSISTANT
Authorized Official Telephone Number:
206-838-6885

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A065470 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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