1609867860 NPI number — DAVID LEE PHILLIPS MS

Table of content: DAVID LEE PHILLIPS MS (NPI 1609867860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609867860 NPI number — DAVID LEE PHILLIPS MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIPS
Provider First Name:
DAVID
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS
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:
1609867860
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1002 10TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SNOHOMISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98290-8300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-953-4361
Provider Business Mailing Address Fax Number:
425-953-4361

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1002 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNOHOMISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98290-2024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-953-4361
Provider Business Practice Location Address Fax Number:
425-953-4361
Provider Enumeration Date:
11/04/2005

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: 101YM0800X , with the licence number:  LH00005361 , 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: 7444PH . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 056368 . This is a "HORIZON BEHAV. SERV. ID #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2030370 . This is a "CIGNA BEHAV. HEALTH ID #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8927542 . This is a "CRIME VICTIMS COMP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 555451001 . This is a "GROUP HEALTH ID #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 205394 . This is a "MANGED HEALTH NETWORK ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 182368 . This is a "COMPSYCH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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