1225163926 NPI number — R & B FLECK ENTERPRISES, LLC

Table of content: (NPI 1225163926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225163926 NPI number — R & B FLECK ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R & B FLECK ENTERPRISES, LLC
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:
1225163926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1365 BEET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLA WALLA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99362-7180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-520-1794
Provider Business Mailing Address Fax Number:
509-529-5860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 CARONDELET DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99354-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-713-4381
Provider Business Practice Location Address Fax Number:
509-529-5860
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLECK
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
WAYNE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
509-240-5054

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  252090019815 , 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: 1328202 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7121478 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G8803274 . This is a "MEDICARE ID GROUP NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1578629226 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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