1306992037 NPI number — PARKWAY GENERAL SURGEONS

Table of content: (NPI 1306992037)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306992037 NPI number — PARKWAY GENERAL SURGEONS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKWAY GENERAL SURGEONS
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:
VANDERGRIEND & VANDERGRIEND
Provider Other Organization Name Type Code:
4
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:
1306992037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2940 SQUALICUM PKWY
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-1892
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-733-0070
Provider Business Mailing Address Fax Number:
360-676-8351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2940 SQUALICUM PKWY
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98225-1892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-733-0070
Provider Business Practice Location Address Fax Number:
360-676-8351
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EBERT
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
360-733-0070

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  602762505 , 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: 7883507 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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