1487605309 NPI number — YAKIMA HMA LLC

Table of content: (NPI 1487605309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487605309 NPI number — YAKIMA HMA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKIMA HMA LLC
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:
1487605309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
732 SUMMITVIEW AVE
Provider Second Line Business Mailing Address:
#633
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98902-3032
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-574-4455
Provider Business Mailing Address Fax Number:
509-574-4481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 S 9TH AVE
Provider Second Line Business Practice Location Address:
ST ELIZABETH HALL
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-574-4455
Provider Business Practice Location Address Fax Number:
509-574-4481
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWAW
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
615-778-8076

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 7121197 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7119589 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7121122 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7124993 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7126626 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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