1366580060 NPI number — OLYMPIA WOMENS HEALTH, P.C.

Table of content: (NPI 1366580060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366580060 NPI number — OLYMPIA WOMENS HEALTH, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPIA WOMENS HEALTH, P.C.
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:
1366580060
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 BLACK HILLS LN SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-8600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-786-1515
Provider Business Mailing Address Fax Number:
360-754-7476

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
403 BLACK HILLS LN SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98502-8600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-786-1515
Provider Business Practice Location Address Fax Number:
360-754-7476
Provider Enumeration Date:
02/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORUZZI
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-786-1515

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  27522 , 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: 105543 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1059781 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com