1194091637 NPI number — N W PEDIATRIC CENTER, INC. P.S.

Table of content: (NPI 1194091637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194091637 NPI number — N W PEDIATRIC CENTER, INC. P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N W PEDIATRIC CENTER, INC. P.S.
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:
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:
1194091637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 COOKS HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTRALIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98531-9073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-736-6778
Provider Business Mailing Address Fax Number:
360-736-6552

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18313 PAULSON ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98579-9262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-736-6778
Provider Business Practice Location Address Fax Number:
360-736-6552
Provider Enumeration Date:
03/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MCKAY
Authorized Official First Name:
LISA
Authorized Official Middle Name:
GAIL
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
360-736-6777

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  D160180464 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00043677 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00048049 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00038226 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00029916 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00027525 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: MD00028578 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD00032554 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: MD00039351 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP60093357 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP60086265 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP30007039 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP30006273 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X , with the licence number: AP30004257 , 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: 8349342 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1058825 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8488298 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9636994 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1072958 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9653551 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9661323 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8141947 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8251324 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9643156 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8173882 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8398356 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 961422 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2010815 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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