1255458261 NPI number — SHORLINE NATUROPATHIC FAMILY HEALTH CENTER

Table of content: (NPI 1255458261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255458261 NPI number — SHORLINE NATUROPATHIC FAMILY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHORLINE NATUROPATHIC FAMILY HEALTH CENTER
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:
COTTAGE CLINIC
Provider Other Organization Name Type Code:
3
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:
1255458261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13346 1ST AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98125-3036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-236-1260
Provider Business Mailing Address Fax Number:
206-361-2605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13346 1ST AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98125-3036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-236-1260
Provider Business Practice Location Address Fax Number:
206-361-2605
Provider Enumeration Date:
03/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHAPMAN
Authorized Official First Name:
GINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICAL ASSISTANT
Authorized Official Telephone Number:
206-361-2602

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC00000601 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 175F00000X , with the licence number: NT00000956 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225700000X , with the licence number: MA00018320 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 175F00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LP2300X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1447287289 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1346349222 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1417984790 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1811068828 . This is a "NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".