1174915151 NPI number — GAIL FAHEY M.D.

Table of content: GAIL FAHEY M.D. (NPI 1174915151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174915151 NPI number — GAIL FAHEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAHEY
Provider First Name:
GAIL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1174915151
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 E FOURTH PLAIN BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98661-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-696-4061
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 E FOURTH PLAIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98661-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-696-4061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2015

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: 103TB0200X , with the licence number:  33780981 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X , with the licence number: 4054878 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 4028798 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 385H00000X , with the licence number: 60167155 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 680-709 . This is a "ICD-9CM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CIMC . This is a "INTERNAL MEDICINE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P100, P300 . This is a "STRUCTURE, STRATEGY, ANALYSIS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 390-459 . This is a "ICD-9CM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: C100, C200, C300 . This is a "COUNSELING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: C400 . This is a "COUNSELING" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CEMC . This is a "EVALUATION AND MANAGEMENT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CFPC . This is a "FAMILY PRACTICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: T1015 . This is a "CLINIC SERVICE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 740-759 . This is a "ICD-9CM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CHONC . This is a "HEMATOLOGY AND ONCOLOGY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: L100, L300, A100 . This is a "CASE ASSESSMENT, DEVELOPMENT, AND ADMINISTRATION" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1174915151 . This is a "PATHOLOGY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 140-239 . This is a "ICD-9-CM" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CEDC . This is a "EMERGENCY DEPARTMENT" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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