1285766469 NPI number — PETER J. MARTIN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285766469 NPI number — PETER J. MARTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER J. MARTIN
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:
1285766469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 629
Provider Second Line Business Mailing Address:
N 115 CROSBY
Provider Business Mailing Address City Name:
TEKOA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99033-0629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-284-2423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NORTH 115 CROSBY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEKOA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99033-0629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-284-2423
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HARP
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
509-284-2423

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  601652856 , 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: 7069875 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7075971 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com