1104255785 NPI number — SARAH VIRGINIA MILES PA-C

Table of content: SARAH VIRGINIA MILES PA-C (NPI 1104255785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104255785 NPI number — SARAH VIRGINIA MILES PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILES
Provider First Name:
SARAH
Provider Middle Name:
VIRGINIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1104255785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19020 33RD AVE W
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036-4748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-301-5100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12040 NE 128TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-1800
Provider Business Practice Location Address Fax Number:
425-899-1804
Provider Enumeration Date:
11/05/2013

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: 363AM0700X , with the licence number:  PA60448342 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: PA60448342 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA60448342 , 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)

  • Identifier: 0442216 . This is a "L & I - SWEDISH RADIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0442190 . This is a "L & I - RADIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0442225 . This is a "L & I - SOUTH SOUND RADIOLOGY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0442192 . This is a "L & I - RADIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0442230 . This is a "L & I - VANCOUVER RADIOLOGISTS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0442216 . This is a "L & I - EVERGREEN RADIA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0442228 . This is a "L & I - SEATTLE RADIOLOGY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2035102 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".