1548426091 NPI number — PMO CARE, PLLC

Table of content: (NPI 1548426091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548426091 NPI number — PMO CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PMO CARE, PLLC
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:
INTEGRA HEALTH
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:
1548426091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1215 120TH AVE NE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-283-4200
Provider Business Mailing Address Fax Number:
425-679-5679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 120TH AVE NE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-283-4200
Provider Business Practice Location Address Fax Number:
425-679-5679
Provider Enumeration Date:
08/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FRANSKOUSKY
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
425-283-4200

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD159813 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QA0401X , with the licence number: MD0016837 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RA0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084A0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X , with the licence number: 602725791 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: G8879133 . This is a "PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2047471 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".