1750321121 NPI number — MONICA CLARE MURRAY BSPT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750321121 NPI number — MONICA CLARE MURRAY BSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MURRAY
Provider First Name:
MONICA
Provider Middle Name:
CLARE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSPT
Provider Gender Code:
F

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:
1750321121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9315 GRAVELLY LAKE DR SW
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98499-1574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-581-5200
Provider Business Mailing Address Fax Number:
253-581-5203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7727 40TH ST W
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
UNIVERSITY PLACE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98466-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-460-1362
Provider Business Practice Location Address Fax Number:
253-460-6628
Provider Enumeration Date:
06/07/2006

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: 225100000X , with the licence number:  PT00006294 , 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: 8441842 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4677MU . This is a "BLUE SHIELD # VM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0206081 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7715MU . This is a "REGENCE BLUESHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8940832 . This is a "L&I CRIME VICTIMS PRGM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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