1669742714 NPI number — B FIT PREVENTIVE CARE CLINIC

Table of content: (NPI 1669742714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669742714 NPI number — B FIT PREVENTIVE CARE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
B FIT PREVENTIVE CARE CLINIC
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:
THE B. FIT CLINIC
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:
1669742714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1447
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98631-1447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-642-7246
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 PACIFIC AVE N
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98631-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-642-7246
Provider Business Practice Location Address Fax Number:
360-642-3006
Provider Enumeration Date:
01/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BOLEY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER/NURSE PRACTITIONER
Authorized Official Telephone Number:
360-642-7246

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com