1861639965 NPI number — SIVAD PRIMARY CARE AND ASSOCIATES P.C.

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 1861639965 NPI number — SIVAD PRIMARY CARE AND ASSOCIATES P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIVAD PRIMARY CARE AND ASSOCIATES P.C.
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:
1861639965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9019 GARNERS FERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29061-9540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-318-5004
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 ALDER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUMNER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98390-1454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-240-9599
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2009

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
S.
Authorized Official Middle Name:
ASKIA
Authorized Official Title or Position:
C.E.O. / FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
803-318-5004

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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