1295768828 NPI number — CHRISTOPHER R BOEGER PA-C

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 1295768828 NPI number — CHRISTOPHER R BOEGER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOEGER
Provider First Name:
CHRISTOPHER
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

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:
1295768828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5299
Provider Second Line Business Mailing Address:
MS: 315-J1-TRM
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98415-0299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-403-7537
Provider Business Mailing Address Fax Number:
253-403-7539

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
315 MARTIN LUTHER KING JR WAY
Provider Second Line Business Practice Location Address:
MS: 315-J1-TRM
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405-4234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-403-7537
Provider Business Practice Location Address Fax Number:
253-403-7539
Provider Enumeration Date:
07/08/2006

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: 363AS0400X , with the licence number:  PA10004154 , 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: 8160BO . This is a "REGENCE PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8362196 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8930049 . This is a "CRIME VICTIMS COMP PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 179344 . This is a "DEPT OF L&I PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: B003 . This is a "TRICARE PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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