1619041456 NPI number — KAREN SKIDMORE DPM PS

Table of content: (NPI 1275588329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619041456 NPI number — KAREN SKIDMORE DPM PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKIDMORE
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM PS
Provider Gender Code:
F

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:
1619041456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20700 BOND RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POULSBO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98370-9099
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-697-3668
Provider Business Mailing Address Fax Number:
360-697-3610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20700 BOND RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-9099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-697-3668
Provider Business Practice Location Address Fax Number:
360-697-3610
Provider Enumeration Date:
11/20/2006

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: 213EP1101X , with the licence number:  PO00000508 , 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: WA9999 . This is a "MUTUAL OF OMAHA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0166066 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8477598 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA5130 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 00010913 . This is a "PACIFICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 91217091100 . This is a "UNIFORM MEDICAL PLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 141708141710 . This is a "PREMERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 4550430 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2106608 . This is a "COMMUNITY HLTH NETWORK WA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9121709110001 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 91217091101 . This is a "KPS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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