1770527962 NPI number — PATRICK BLAKE WEST IDC

Table of content: PATRICK BLAKE WEST IDC (NPI 1770527962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770527962 NPI number — PATRICK BLAKE WEST IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEST
Provider First Name:
PATRICK
Provider Middle Name:
BLAKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
IDC
Provider Gender Code:
M

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:
1770527962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50A FREEMAN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98312-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-373-4103
Provider Business Mailing Address Fax Number:
360-396-4742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USS LOUISIANA SSBN 743 (BLUE)
Provider Second Line Business Practice Location Address:
2100 THRESHER AVE
Provider Business Practice Location Address City Name:
SILVERDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98315-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-315-4206
Provider Business Practice Location Address Fax Number:
360-396-4742
Provider Enumeration Date:
06/16/2006

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: 1710I1002X , 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)