1255492179 NPI number — MICHAEL HENRY ARNDORFER RPH

Table of content: MICHAEL HENRY ARNDORFER RPH (NPI 1255492179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255492179 NPI number — MICHAEL HENRY ARNDORFER RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNDORFER
Provider First Name:
MICHAEL
Provider Middle Name:
HENRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
M

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:
1255492179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 BRIAR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-7811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-739-4597
Provider Business Mailing Address Fax Number:
360-752-6437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 RIMLAND DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98226-5664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-650-8210
Provider Business Practice Location Address Fax Number:
360-752-6437
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PH60299021 , 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)





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