1407936586 NPI number — DR. VINCE L FITZPATRICK DC

Table of content: DR. VINCE L FITZPATRICK DC (NPI 1407936586)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407936586 NPI number — DR. VINCE L FITZPATRICK DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZPATRICK
Provider First Name:
VINCE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FITZPATRICK
Provider Other First Name:
VINCE
Provider Other Middle Name:
L.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1407936586
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 340
Provider Second Line Business Mailing Address:
18211 E APPLEWAY
Provider Business Mailing Address City Name:
GREENACRES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-926-1551
Provider Business Mailing Address Fax Number:
509-926-1661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18211 E APPLEWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENACRES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-926-1551
Provider Business Practice Location Address Fax Number:
509-926-1661
Provider Enumeration Date:
10/16/2006

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: 111N00000X , with the licence number:  CH00001085 , 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: 2315505 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 350016953 . This is a "RR MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 14817 . This is a "L I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: E11435 . This is a "ASURIS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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