1568475408 NPI number — DEACON'S MEDICAL EQUIPMENT

Table of content: (NPI 1568475408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568475408 NPI number — DEACON'S MEDICAL EQUIPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEACON'S MEDICAL EQUIPMENT
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:
1568475408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 N. MAIN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLFAX
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-397-3345
Provider Business Mailing Address Fax Number:
509-397-2966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 N. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLFAX
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-397-3345
Provider Business Practice Location Address Fax Number:
509-397-2966
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEACON
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-397-3345

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  601678679 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BD1200X , with the licence number: 601678679 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 601678679 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 601678679 , 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: 9041856 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805724000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9009283 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9041864 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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