1366529570 NPI number — DR. WILLIAM RYAN ERRICO D.O.

Table of content: DR. WILLIAM RYAN ERRICO D.O. (NPI 1366529570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366529570 NPI number — DR. WILLIAM RYAN ERRICO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERRICO
Provider First Name:
WILLIAM
Provider Middle Name:
RYAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERRICO
Provider Other First Name:
BILL
Provider Other Middle Name:
RYAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1366529570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 N CHELAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801-2028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-663-8711
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1337 S SAM HOUSTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65483-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-967-5435
Provider Business Practice Location Address Fax Number:
417-967-5503
Provider Enumeration Date:
11/01/2006

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: 207Q00000X , with the licence number:  OP00002103 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 2022032258 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0263251 . This is a "WASHINGTON LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2008275 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200124350 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 26D0889777 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 26D0679044 . This is a "CLIA" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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