1710274493 NPI number — DR. ASHLEIGH RENE PAVEY MD, MBA

Table of content: DR. ASHLEIGH RENE PAVEY MD, MBA (NPI 1710274493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710274493 NPI number — DR. ASHLEIGH RENE PAVEY MD, MBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAVEY
Provider First Name:
ASHLEIGH
Provider Middle Name:
RENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BORGES
Provider Other First Name:
ASHLEIGH
Provider Other Middle Name:
RENE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710274493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MADIGAN ARMY MEDICAL CENTER
Provider Second Line Business Mailing Address:
9040 JACKSON AVE, THIRD FLOOR
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-5600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-0895
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-5600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
532-968-2483
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2011

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: 208000000X , with the licence number:  0101252541 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080N0001X , with the licence number: 0101252541 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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