1356682470 NPI number — TRAVELING PAIN MANAGEMENT DOCTORS PSC

Table of content: DR. CHANDRA K. SACHETI M.D (NPI 1124087655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356682470 NPI number — TRAVELING PAIN MANAGEMENT DOCTORS PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRAVELING PAIN MANAGEMENT DOCTORS PSC
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:
1356682470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21234 SE 273RD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98038-3350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-389-6945
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21234 SE 273RD PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98038-3350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-389-6945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MANCUSO
Authorized Official First Name:
TRACI
Authorized Official Middle Name:
M
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
509-389-6945

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30006855 , 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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