1255606356 NPI number — MR. HAYWARD COLEMAN JR. BA LIBERAL ARTS

Table of content: MR. HAYWARD COLEMAN JR. BA LIBERAL ARTS (NPI 1255606356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255606356 NPI number — MR. HAYWARD COLEMAN JR. BA LIBERAL ARTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COLEMAN
Provider First Name:
HAYWARD
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
BA LIBERAL ARTS
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:
1255606356
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 S GRADY WAY
Provider Second Line Business Mailing Address:
SUITE 533
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-3220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-235-9386
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 S GRADY WAY
Provider Second Line Business Practice Location Address:
SUITE 533
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98057-3220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-235-9386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2012

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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