1700379682 NPI number — VERA WHOLE HEALTH WA PC

Table of content: (NPI 1700379682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700379682 NPI number — VERA WHOLE HEALTH WA PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERA WHOLE HEALTH WA 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:
AMY'S FAMILY HEALTH CENTER
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:
1700379682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 2ND AVE STE 1400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98101-3020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-398-7870
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 PHIL MEADOR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-810-4715
Provider Business Practice Location Address Fax Number:
208-473-2964
Provider Enumeration Date:
06/14/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HIRSCHFELDER
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
LICENSING ANALYST
Authorized Official Telephone Number:
206-395-7870

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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