1740201938 NPI number — YAKIMA VALLEY PROFESSIONAL SERVICES ON TIETON, PC

Table of content: FLORETTE KAPINGA TSHIABA MD (NPI 1982231049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740201938 NPI number — YAKIMA VALLEY PROFESSIONAL SERVICES ON TIETON, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAKIMA VALLEY PROFESSIONAL SERVICES ON TIETON, 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:
APPLE VALLEY FAMILY MEDICINE
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:
1740201938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2947
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YAKIMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98907-2947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-248-7849
Provider Business Mailing Address Fax Number:
509-249-5042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 S 38TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YAKIMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98902-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-965-1035
Provider Business Practice Location Address Fax Number:
509-965-1580
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIMMONS
Authorized Official First Name:
JIM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
509-248-7849

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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