1902562333 NPI number — AMFM HEALTHCARE WASHINGTON

Table of content: (NPI 1902562333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902562333 NPI number — AMFM HEALTHCARE WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMFM HEALTHCARE WASHINGTON
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:
MISSION CONNECTION HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1902562333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30310 RANCHO VIEJO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN CAPISTRANO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92675-1576
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-558-5479
Provider Business Mailing Address Fax Number:
949-579-2876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6990 E GREEN LAKE WAY N
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-558-5479
Provider Business Practice Location Address Fax Number:
949-579-2876
Provider Enumeration Date:
11/10/2021

Additional Information

Authorized Official

Authorized Official Last Name:
FARBMAN
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
949-424-9921

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: BHA.FS.61272048 . This is a "WASHINGTON STATE DEPARTMENT OF HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 578314 . This is a "THE JOINT COMMISSION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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