1295889335 NPI number — RICHARD WILLIAM GILES BC-HIS

Table of content: RICHARD WILLIAM GILES BC-HIS (NPI 1295889335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295889335 NPI number — RICHARD WILLIAM GILES BC-HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILES
Provider First Name:
RICHARD
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BC-HIS
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:
1295889335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6132 BROADVIEW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661-6900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-690-4327
Provider Business Mailing Address Fax Number:
360-690-0043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8317 E MILL PLAIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-690-4327
Provider Business Practice Location Address Fax Number:
360-690-0043
Provider Enumeration Date:
01/23/2007

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: 237700000X , with the licence number:  HAS-P-647063 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: HA00000347 , 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: 2130657 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 356890201 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 131329 . This is a "DEPT LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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