1417118472 NPI number — DAVID F. PRATT MD PS

Table of content: (NPI 1417118472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417118472 NPI number — DAVID F. PRATT MD PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID F. PRATT MD PS
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:
SOGAB SURGERY CENTER
Provider Other Organization Name Type Code:
5
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:
1417118472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10413 NE 37TH CIR
Provider Second Line Business Mailing Address:
BUILDING 3 SUITE B
Provider Business Mailing Address City Name:
KIRKLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98033-7924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-285-2112
Provider Business Mailing Address Fax Number:
425-803-0218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10413 NE 37TH CIR
Provider Second Line Business Practice Location Address:
BLDG 3, STE B
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98033-7924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-285-2112
Provider Business Practice Location Address Fax Number:
425-803-0218
Provider Enumeration Date:
06/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRATT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
425-754-6260

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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