1407854953 NPI number — SNOHOMISH COUNTY

Table of content: (NPI 1407854953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407854953 NPI number — SNOHOMISH COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNOHOMISH COUNTY
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:
SNOHOMISH COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
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:
1407854953
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3020 RUCKER AVE SUITE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-339-8711
Provider Business Mailing Address Fax Number:
425-339-5216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3020 RUCKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-339-8711
Provider Business Practice Location Address Fax Number:
425-339-5216
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
AGUILAR
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
DEPARTMENT DEPUTY DIRECTOR
Authorized Official Telephone Number:
425-339-8690

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251K00000X , with the licence number: MD00023980 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7407869 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7408404 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7099922 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900923 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7407885 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7098130 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7408370 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7408362 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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