1184693897 NPI number — DR. KELLY JAMES COCHRANE OD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184693897 NPI number — DR. KELLY JAMES COCHRANE OD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

COCHRANE

Provider First Name:

KELLY

Provider Middle Name:

JAMES

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

OD

Provider Gender Code:

M

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:

1184693897

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/04/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 4013

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PASCO

Provider Business Mailing Address State Name:

WA

Provider Business Mailing Address Postal Code:

99302-4013

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

509-547-6998

Provider Business Mailing Address Fax Number:

509-547-6966

Provider First Line Business Practice Location Address:

9825 SANDIFUR PKWY

Provider Second Line Business Practice Location Address:

SUITE B

Provider Business Practice Location Address City Name:

PASCO

Provider Business Practice Location Address State Name:

WA

Provider Business Practice Location Address Postal Code:

99301-6738

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

509-547-6998

Provider Business Practice Location Address Fax Number:

509-547-6966

Provider Enumeration Date:

03/15/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  1536TX , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 152W00000X , with the licence number: 1629D , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 410016585 . This is a "UPPR" identifier . This identifiers is of the category "OTHER".
• Identifier: 022886003 . This is a "REGENCE OREGON" identifier . This identifiers is of the category "OTHER".
• Identifier: 032340000 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2009488 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
• Identifier: CO6992 . This is a "REGENCE WASHINGTON" identifier . This identifiers is of the category "OTHER".
• Identifier: 554048 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 610605300 . This is a "DEPT OF LABOR SEATTLE DFE" identifier . This identifiers is of the category "OTHER".
• Identifier: 8886644808 . This is a "COMM HEALTH PLAN OF WA" identifier . This identifiers is of the category "OTHER".
• Identifier: 25764890 . This is a "GROUP HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 410016584 . This is a "TRAVELERS MEDICARE RETIRE" identifier . This identifiers is of the category "OTHER".
• Identifier: 0323400001 . This is a "MC SUPPY CIGNA DMERC REGD" identifier . This identifiers is of the category "OTHER".
• Identifier: 0226424 . This is a "DEPT LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".