1730189440 NPI number — MISSION HEALTHCARE AT BELLEVUE, JOINT VENTURE

Table of content: (NPI 1730189440)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730189440 NPI number — MISSION HEALTHCARE AT BELLEVUE, JOINT VENTURE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION HEALTHCARE AT BELLEVUE, JOINT VENTURE
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:
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:
1730189440
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1969
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIG HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98335-3969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-853-4457
Provider Business Mailing Address Fax Number:
253-853-5280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2424 156TH AVE NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98007-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-897-8800
Provider Business Practice Location Address Fax Number:
425-897-8801
Provider Enumeration Date:
07/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOICE
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
425-897-8806

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1365 , 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: 4113650 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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