1124003223 NPI number — PHILLIP A RUFF MPT, CHT

Table of content: PHILLIP A RUFF MPT, CHT (NPI 1124003223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124003223 NPI number — PHILLIP A RUFF MPT, CHT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RUFF
Provider First Name:
PHILLIP
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPT, CHT
Provider Gender Code:
M

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:
1124003223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NE MOTHER JOSEPH PL
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98664-3299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-254-6161
Provider Business Mailing Address Fax Number:
360-449-1139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 NE MOTHER JOSEPH PL
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98664-3299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-254-6161
Provider Business Practice Location Address Fax Number:
360-449-1139
Provider Enumeration Date:
12/12/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251H1200X , with the licence number:  3039 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251H1200X , with the licence number: PT00007743 , 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: 098565018 . This is a "BCBS OF OR" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 8434649 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 295474 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173399 . This is a "WA L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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