1598785651 NPI number — PAUL A. ZAVERUHA, MD PS, INC

Table of content: (NPI 1598785651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598785651 NPI number — PAUL A. ZAVERUHA, MD PS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL A. ZAVERUHA, MD PS, INC
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:
PAUL A. ZAVERUHA, MD PS, INC
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:
1598785651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1080
Provider Second Line Business Mailing Address:
101 NE BIRCH ST
Provider Business Mailing Address City Name:
COUPEVILLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98239-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-678-6433
Provider Business Mailing Address Fax Number:
360-678-6812

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 NE BIRCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUPEVILLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-678-6433
Provider Business Practice Location Address Fax Number:
360-678-6812
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZAVERUHA
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-678-6433

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  601799900 , 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: 378259003 . This is a "GROUP HEALTH ID NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 911826264 98239 A001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7088347 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 911826264 SU5491 . This is a "REGENCE BLUESHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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