1518034180 NPI number — N.W. PEDIATRIC CENTER INC PS

Table of content: (NPI 1518034180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518034180 NPI number — N.W. PEDIATRIC CENTER INC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N.W. PEDIATRIC CENTER INC 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:
NORTHWEST PEDIATRIC CENTER
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:
1518034180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 COOKS HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98531-9073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-736-6778
Provider Business Mailing Address Fax Number:
360-736-6552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1911 COOKS HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98531-9073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-736-6778
Provider Business Practice Location Address Fax Number:
360-736-6552
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKAY
Authorized Official First Name:
LISA
Authorized Official Middle Name:
GAIL
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
360-736-6778

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD00029916 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: MD00038226 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00028578 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00027525 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00032554 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00043677 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: MD00039351 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP30006273 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP30007039 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP60086265 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1058825 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 218107 . This is a "JC PROVIDENCE HEALTH PLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2914LO . This is a "DR LO REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9116SM . This is a "DANA SMITH, ARNP REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1194SM . This is a "DANA SMITH, ARNP REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2914CA . This is a "JENNIFER CASERTA, MD REGE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2914SM . This is a "DANA SMITH, ARNP REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2915CA . This is a "JENNIFER CASERTA, MD REGE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8024LO . This is a "DR LO REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9116CA . This is a "JENNIFER CASETA, MD REGEN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1914LO . This is a "DR. LO REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8173882 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212864 . This is a "DANA SMITH, ARNP PROVIDEN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 230532008 . This is a "JC GROUP HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7057375 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8141947 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1072958 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8251324 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8398356 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9636994 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com