1164464053 NPI number — JOHN C SCHIRA PA C

Table of content: JOHN C SCHIRA PA C (NPI 1164464053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164464053 NPI number — JOHN C SCHIRA PA C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHIRA
Provider First Name:
JOHN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA C
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:
1164464053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6700 MARTIN WAY E
Provider Second Line Business Mailing Address:
SUITE 117
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98516-6502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-413-6910
Provider Business Mailing Address Fax Number:
360-413-9026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 MARTIN WAY E
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98516-6502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-413-6910
Provider Business Practice Location Address Fax Number:
360-413-9026
Provider Enumeration Date:
06/12/2006

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: 363A00000X , with the licence number:  PA10001917 , 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: SC0968 . This is a "BSWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0137179 . This is a "LIWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8348971 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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