1194859785 NPI number — KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Table of content: (NPI 1194859785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194859785 NPI number — KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
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:
1194859785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2921 NACHES AVE SW
Provider Second Line Business Mailing Address:
RCA-B1N-04
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-630-2222
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4102 S REGAL ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99223-7737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-2277
Provider Business Practice Location Address Fax Number:
509-434-3182
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIOTT
Authorized Official First Name:
GAIL
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
PROGRAM MGR, RX REGULATORY
Authorized Official Telephone Number:
206-630-2222

Provider Taxonomy Codes

  • Taxonomy code: 3336C0002X , with the licence number:  CF00003595 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: CF00003595 , 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: 4923985 . This is a "NCPDP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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