1821802190 NPI number — HEMLOCK HEALTH PLLC

Table of content: (NPI 1821802190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821802190 NPI number — HEMLOCK HEALTH PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMLOCK HEALTH PLLC
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:
1821802190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2285 SPRUCE GOOSE ST APT A130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89135-2631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-499-3370
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17875 REDMOND WAY STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052-4936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-499-3370
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2025

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SRAN
Authorized Official First Name:
MANPREET
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
559-499-3370

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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