1154912673 NPI number — IMMINENT HEALTH PLLC

Table of content: (NPI 1154912673)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154912673 NPI number — IMMINENT HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IMMINENT HEALTH PLLC
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:
1154912673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1031 N KELLOGG ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-7661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 N KELLOGG ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-7661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-460-1065
Provider Business Practice Location Address Fax Number:
509-495-1143
Provider Enumeration Date:
01/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CAMPBELL
Authorized Official First Name:
CURTIS
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
509-834-1740

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8246290 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: OP0001658 . This is a "WA OSTEOPATHIC BOARD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: PA60178683 . This is a "WA ALLOPATHIC BOARD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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