1023253374 NPI number — BOURGET HEALTH SERVICES INC

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 1023253374 NPI number — BOURGET HEALTH SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOURGET HEALTH SERVICES 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:
PATHOLOGY ASSOCIATES MED LABORATORIES
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:
1023253374
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99220-2687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-755-8600
Provider Business Mailing Address Fax Number:
509-755-8319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 W CLIFF DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-3638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-755-8600
Provider Business Practice Location Address Fax Number:
509-755-8319
Provider Enumeration Date:
12/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
KURT
Authorized Official Middle Name:
Authorized Official Title or Position:
CFP
Authorized Official Telephone Number:
509-755-8903

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  MTS-0416 , 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: 7010937 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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