1255387742 NPI number — MS. VALERIE MARGARET MCLEOD PT

Table of content: MS. VALERIE MARGARET MCLEOD PT (NPI 1255387742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255387742 NPI number — MS. VALERIE MARGARET MCLEOD PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCLEOD
Provider First Name:
VALERIE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEATH
Provider Other First Name:
VALERIE
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255387742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 637
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAIR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-275-4352
Provider Business Mailing Address Fax Number:
360-275-5692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 NE MEDICAL CENTER ROAD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BELFAIR
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-275-4352
Provider Business Practice Location Address Fax Number:
360-275-5692
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT00002351 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT8573 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 8920647 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 33281 . This is a "PROVIDER STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7014301 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022593 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: MC2314 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 33180 . This is a "FACILITY STATE L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 91117966403 . This is a "KITSAP PHYSICIAN SVC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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