1508820879 NPI number — NEW HEALTH PROGRAM ASSOCIATION

Table of content: (NPI 1508820879)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508820879 NPI number — NEW HEALTH PROGRAM ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HEALTH PROGRAM ASSOCIATION
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:
NEW HEALTH COLVILLE DENTAL
Provider Other Organization Name Type Code:
3
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:
1508820879
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 808
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEWELAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99109-0808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-935-6001
Provider Business Mailing Address Fax Number:
509-935-4196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 E 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99114-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-684-1440
Provider Business Practice Location Address Fax Number:
509-684-1277
Provider Enumeration Date:
04/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POE
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
509-935-6001

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  J600317870 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 80300 . This is a "LABOR AND INDUSTRIES ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5024922 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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