1245293802 NPI number — ASTHMA & ALLERGY CENTER OF WHATCOM COUNTY, P.S.

Table of content: (NPI 1245293802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245293802 NPI number — ASTHMA & ALLERGY CENTER OF WHATCOM COUNTY, P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASTHMA & ALLERGY CENTER OF WHATCOM COUNTY, P.S.
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:
1245293802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5495
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98415-0495
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-756-2000
Provider Business Mailing Address Fax Number:
360-756-2111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2075 BARKLEY BLVD
Provider Second Line Business Practice Location Address:
STE 220
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98226-6614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-756-2000
Provider Business Practice Location Address Fax Number:
360-756-2111
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
HOWARD
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT
Authorized Official Telephone Number:
360-756-2000

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X , with the licence number:  MD00031780 , 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: 1110485 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com