1427252147 NPI number — DR. DAVE S ATTEBERRY MD

Table of content: DR. DAVE S ATTEBERRY MD (NPI 1427252147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427252147 NPI number — DR. DAVE S ATTEBERRY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATTEBERRY
Provider First Name:
DAVE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1427252147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6101 SUMMITVIEW AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98908-3028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-902-8857
Provider Business Mailing Address Fax Number:
509-902-8855

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6101 SUMMITVIEW AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98908-3028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-902-8857
Provider Business Practice Location Address Fax Number:
509-902-8855
Provider Enumeration Date:
06/14/2007

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: 207T00000X , with the licence number:  MD422565 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: MD60125290 , 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: 426319 . This is a "EMPLOYER CLINIC L&I GR. NO.: DIRECT IMAGING, PC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1326340969 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1689283285 . This is a "EMPLOYER NPI: DIRECT IMAGING, PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0271934 . This is a "L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G9016479 . This is a "EMPLOYER PTAN: DIRECT IMAGING, PC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 426432 . This is a "EMPLOYER RADIOLOGY L&I GR. NO.: DIRECT IMAGING, PC" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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