1316132731 NPI number — CLEARVIEW CLINIC

Table of content: (NPI 1316132731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316132731 NPI number — CLEARVIEW CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEARVIEW CLINIC
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:
1316132731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18122 SR 9 SE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
SNOHOMISH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98296-5384
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-481-8811
Provider Business Mailing Address Fax Number:
425-486-7427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18122 SR 9 SE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SNOHOMISH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98296-5384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-481-8811
Provider Business Practice Location Address Fax Number:
425-486-7427
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HUNHOLZ
Authorized Official First Name:
BETTY
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER MANAGER
Authorized Official Telephone Number:
425-481-8811

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: R01054 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7003544 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: R01054 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: PA6ZGW-00 . This is a "OHP IDENTIFIER" identifier . This identifiers is of the category "OTHER".




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