1174826002 NPI number — DANIEL D DAVID

Table of content: (NPI 1174826002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174826002 NPI number — DANIEL D DAVID

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL D DAVID
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:
1174826002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
560 SE BISHOP BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PULLMAN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99163-5505
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-334-3300
Provider Business Mailing Address Fax Number:
509-334-7591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 SE BISHOP BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PULLMAN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99163-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-334-3300
Provider Business Practice Location Address Fax Number:
509-334-7591
Provider Enumeration Date:
12/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DAVID
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-334-3300

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD00001643 , 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: 000096751 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3506831 . This is a "CIGNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 00010015358 . This is a "ASURIS NORTHWEST HEALTH PLAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 000301793 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2005718 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000503341 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: DAVDN5371457713 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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