1568411494 NPI number — DR. JURIS M MACS M.D.

Table of content: DR. JURIS M MACS M.D. (NPI 1568411494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568411494 NPI number — DR. JURIS M MACS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACS
Provider First Name:
JURIS
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1568411494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 N H ST
Provider Second Line Business Mailing Address:
5TH FLOOR
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98520-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-537-6414
Provider Business Mailing Address Fax Number:
360-532-6878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1006 N H ST
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98520-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-537-6414
Provider Business Practice Location Address Fax Number:
360-532-6878
Provider Enumeration Date:
05/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  MD00010490 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: A003 . This is a "TRICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: MA1607 . This is a "COUNTY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 022161238 . This is a "MEDICARE RR PROVIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8914472 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 115141600 . This is a "MEDICARE GROUP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 000800078 . This is a "MEDICARE PROVIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1532605 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC4850 . This is a "RR MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 335846100 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012648 . This is a "WA LI PROVIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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