1316147325 NPI number — ADVANCED PRACTICE GERIATRICS, PLLC

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 1316147325 NPI number — ADVANCED PRACTICE GERIATRICS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PRACTICE GERIATRICS, PLLC
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:
1316147325
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHOUGAL
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98671-0928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-335-1700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38324 SE HIDDEN FALLS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHOUGAL
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-335-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HYATT
Authorized Official First Name:
EVE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PRACTICE OWNER
Authorized Official Telephone Number:
360-335-1700

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP30006655 , 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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