1235256918 NPI number — IROC PS

Table of content: (NPI 1235256918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235256918 NPI number — IROC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IROC PS
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:
1235256918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
603 N MISSION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WENATCHEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-884-4357
Provider Business Mailing Address Fax Number:
509-888-4601

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 N MISSION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENATCHEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-884-4357
Provider Business Practice Location Address Fax Number:
509-888-4601
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LATIMER
Authorized Official First Name:
WAYNE
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
OWNER, CLINIC DIRECTOR
Authorized Official Telephone Number:
509-884-4357

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NS0005X , with the licence number: 3606 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: MD 00024041 . This is a "DR. BATSON'S MED. LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1245394253 . This is a "DR. BATSON'S NPI #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: CH00000 3031 . This is a "DR. LATIMER'S DC LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1679615678 . This is a "DR. LATIMER'S NIP #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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