1316138720 NPI number — L. KEITH HANSON PLLC

Table of content: (NPI 1316138720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316138720 NPI number — L. KEITH HANSON PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
L. KEITH HANSON PLLC
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:
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:
1316138720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 337
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREWSTER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98812-0337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-689-2525
Provider Business Mailing Address Fax Number:
509-689-3247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 W. INDIAN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREWSTER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
590-689-2525
Provider Business Practice Location Address Fax Number:
509-689-3247
Provider Enumeration Date:
08/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
MELODIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
509-689-2525

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  503894 , 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: 7126980 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".