1588616080 NPI number — DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588616080 NPI number — DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVITA NEPHROLOGY MEDICAL ASSOCIATES OF WASHINGTON PC
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:
6
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:
1588616080
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60000 FILE #74521
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94160-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-626-6234
Provider Business Mailing Address Fax Number:
866-302-6807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16233 SYLVESTER RD SW
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
BURIEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98166-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-935-5423
Provider Business Practice Location Address Fax Number:
206-935-5469
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GABRIEL
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
EFTHIM
Authorized Official Title or Position:
OWNER PRESIDENT SECRETARY & TREASUR
Authorized Official Telephone Number:
800-310-4872

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346276797 . This is a "RICHLAND NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7126378 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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