1225136385 NPI number — BD NORTH BEND I, LLC

Table of content: (NPI 1225136385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225136385 NPI number — BD NORTH BEND I, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BD NORTH BEND I, LLC
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:
1225136385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3326 160TH AVE SE
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98008-6418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-392-4066
Provider Business Mailing Address Fax Number:
425-623-1517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 CEDAR AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BEND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98045-8262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-888-2129
Provider Business Practice Location Address Fax Number:
425-888-2168
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DEVORE
Authorized Official First Name:
DOUG
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
425-392-4066

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  NH1431 , 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: 4111878 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4114310 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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