1093001489 NPI number — GOOD NIGHT MEDICAL OF WASHINGTON, INC.

Table of content: (NPI 1093001489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093001489 NPI number — GOOD NIGHT MEDICAL OF WASHINGTON, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD NIGHT MEDICAL OF WASHINGTON, INC.
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:
6
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:
1093001489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
975 EASTWIND DR
Provider Second Line Business Mailing Address:
SUITE 165
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43081-5322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-384-7433
Provider Business Mailing Address Fax Number:
614-386-0278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16515 MERIDIAN E
Provider Second Line Business Practice Location Address:
SUITE 203B
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98375-6251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-517-3680
Provider Business Practice Location Address Fax Number:
614-386-0278
Provider Enumeration Date:
06/23/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RUDY
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-499-0776

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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