1790966851 NPI number — DPMSALTONPRWA LLC

Table of content: (NPI 1790966851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790966851 NPI number — DPMSALTONPRWA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DPMSALTONPRWA LLC
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:
1790966851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 50150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98015-0150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-228-5228
Provider Business Mailing Address Fax Number:
425-228-5733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11201 88TH AVE E
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98373-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-841-3668
Provider Business Practice Location Address Fax Number:
253-841-0878
Provider Enumeration Date:
11/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SALTON
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
LYN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
253-841-3668

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  PO00000834 , 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: 7141864 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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