1386028397 NPI number — 800 MEDCALF LANE NORTH OPERATIONS LLC

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 1386028397 NPI number — 800 MEDCALF LANE NORTH OPERATIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
800 MEDCALF LANE NORTH OPERATIONS LLC
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:
1386028397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 N MEDCALF LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTESANO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98563-1318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-249-2273
Provider Business Mailing Address Fax Number:
360-249-2363

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N MEDCALF LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTESANO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98563-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-249-2273
Provider Business Practice Location Address Fax Number:
360-249-2363
Provider Enumeration Date:
07/20/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BERG
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
505-468-4742

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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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