1356314967 NPI number — STEPHEN B HILLIS MD

Table of content: STEPHEN B HILLIS MD (NPI 1356314967)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356314967 NPI number — STEPHEN B HILLIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILLIS
Provider First Name:
STEPHEN
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1356314967
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 S CEDAR ST
Provider Second Line Business Mailing Address:
#108
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98405-2308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-212-0078
Provider Business Mailing Address Fax Number:
253-212-3877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 S CEDAR
Provider Second Line Business Practice Location Address:
#108
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-212-0078
Provider Business Practice Location Address Fax Number:
253-212-3877
Provider Enumeration Date:
02/13/2006

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: 207Q00000X , with the licence number:  MD00034263 , 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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