1356309330 NPI number — DOCTORS CLINIC APC

Table of content: (NPI 1356309330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356309330 NPI number — DOCTORS CLINIC APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS CLINIC APC
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:
6
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:
1356309330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9621 RIDGETOP BLVD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVERDALE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98383-8502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2512 WHEATON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98310-3399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-782-3600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
360-782-3600

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X , 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: 8914602 . This is a "CVCP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 50D0911681 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 75420 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8914602 . This is a "CRIME VICTIMS COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7041312 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CU0247 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 20337 . This is a "COAL MINE WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 337018601 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".




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