1144437211 NPI number — COUNTY OF FRANKLIN

Table of content: (NPI 1144437211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144437211 NPI number — COUNTY OF FRANKLIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF FRANKLIN
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:
1144437211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-269-4900
Provider Business Mailing Address Fax Number:
509-269-4977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22210 GLADE ROAD NO.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-269-4900
Provider Business Practice Location Address Fax Number:
509-269-4977
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHUBERT
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
509-269-4900

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  11X01 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9505207 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: WA51516SP . This is a "MOLINA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 9505207 . This is a "BLUE CROSS HERITAGE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0058885 . This is a "DEPT. OF LABOR & INDUSTRI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 52580126 . This is a "COMMUNITY HEALTH PLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9505207 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9505207 . This is a "DSHS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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