1710081351 NPI number — SCOT K MOHR PHYSICIAN ASSISTNAT

Table of content: ARTHUR HERSHEL SCHURGIN D.O. (NPI 1730125998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710081351 NPI number — SCOT K MOHR PHYSICIAN ASSISTNAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOHR
Provider First Name:
SCOT
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICIAN ASSISTNAT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOHR
Provider Other First Name:
K
Provider Other Middle Name:
SCOT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1710081351
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
BLDG R3722, STRYKER AVE.
Provider Second Line Business Mailing Address:
4TH BN, 160TH SOAR, AID STATION, MAIL STOP 23B
Provider Business Mailing Address City Name:
FORT LEWIS
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-966-6791
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG R3722, STRYKER AVE.
Provider Second Line Business Practice Location Address:
4TH BN, 160TH SOAR, AID STATION, MAIL STOP 23B
Provider Business Practice Location Address City Name:
FORT LEWIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-966-6791
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2006

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: 363A00000X , with the licence number:  PA10003901 , 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)





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