1336118496 NPI number — MR. KEVIN B AYERS OD

Table of content: MR. KEVIN B AYERS OD (NPI 1336118496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336118496 NPI number — MR. KEVIN B AYERS OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYERS
Provider First Name:
KEVIN
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1336118496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 W CLEARWATER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-2636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-735-1312
Provider Business Mailing Address Fax Number:
509-736-6403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 W CLEARWATER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-2636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-735-1312
Provider Business Practice Location Address Fax Number:
509-736-6403
Provider Enumeration Date:
03/14/2006

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: 152W00000X , with the licence number:  WA1690 , 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: 5239650001 . This is a "DMERC REGION D" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: DB9688 . This is a "PALMETTO GBA RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2004356 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146425100000 . This is a "PREMERA BLUE CROSS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 481279263AA . This is a "UNIFORM MEDICAL" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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