1003354150 NPI number — KELLEY-ROSS AND ASSOCIATES, INC

Table of content: (NPI 1003354150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003354150 NPI number — KELLEY-ROSS AND ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KELLEY-ROSS AND ASSOCIATES, INC
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:
1003354150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2324 EASTLAKE AVE E
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98102-3345
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-838-4567
Provider Business Mailing Address Fax Number:
206-838-4598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
805 MADISON ST
Provider Second Line Business Practice Location Address:
SUITE 702
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98104-1172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-838-4584
Provider Business Practice Location Address Fax Number:
206-838-4598
Provider Enumeration Date:
02/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BEACH
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
206-838-4544

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com