1306984554 NPI number — WEST COAST HEARING CLINIC INC

Table of content: (NPI 1306984554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306984554 NPI number — WEST COAST HEARING CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST COAST HEARING CLINIC INC
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:
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:
1306984554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 W 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98520-6110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-533-0633
Provider Business Mailing Address Fax Number:
360-533-2541

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABERDEEN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98520-6110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-533-0633
Provider Business Practice Location Address Fax Number:
360-533-2541
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCOONES
Authorized Official First Name:
MARK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DOCTOR OF AUDIOLOGY PRESIDENT
Authorized Official Telephone Number:
360-533-0633

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  951 , 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: 96368 48014 . This is a "HEARPO" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7078355 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65266 . This is a "WA DEPT OF L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9042599 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2100250 1100565 . This is a "COMMUNITY HEALTH PLANWA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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