1114058195 NPI number — COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY

Table of content: (NPI 1114058195)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114058195 NPI number — COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH CENTER OF SNOHOMISH COUNTY
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:
6
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:
1114058195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13060
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98206-3060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-789-3700
Provider Business Mailing Address Fax Number:
425-789-3750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4111 194TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-835-5204
Provider Business Practice Location Address Fax Number:
425-835-5205
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
KENNETH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PT ACCOUNT MANAGER
Authorized Official Telephone Number:
425-789-3700

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  7034036 , 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: 8934243 . This is a "CRIME VICTIMS COMPENSATIO" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 32770 . This is a "WORKMEN COMPENSATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5010921 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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