1174791974 NPI number — KENNETH J RITTER MD PLLC

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 1174791974 NPI number — KENNETH J RITTER MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNETH J RITTER MD 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:
1174791974
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 SO. UNION AVE
Provider Second Line Business Mailing Address:
A-201
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-272-3149
Provider Business Mailing Address Fax Number:
253-272-3348

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 SOUTH UNION
Provider Second Line Business Practice Location Address:
A-201
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-272-3149
Provider Business Practice Location Address Fax Number:
253-272-3348
Provider Enumeration Date:
02/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RITTER
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-272-3149

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X , with the licence number:  05834 , 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: 1726900 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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