1447679402 NPI number — NORCO, INC

Table of content: (NPI 1447679402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447679402 NPI number — NORCO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORCO, INC
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:
1447679402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1125 W AMITY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83705-5412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-336-1643
Provider Business Mailing Address Fax Number:
208-343-4615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1439 DALLES MILITARY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLA WALLA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99362-9544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-525-1066
Provider Business Practice Location Address Fax Number:
509-522-2361
Provider Enumeration Date:
04/07/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SEWARD
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE VICE PRESIDENT MEDICAL
Authorized Official Telephone Number:
208-336-1643

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 500680090 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1447679402 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1447679402 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".