1417022484 NPI number — DR. WILLIAM BALOGH

Table of content: SHEENA MAHABEER PHYSICIAN ASSISTANT (NPI 1528590551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417022484 NPI number — DR. WILLIAM BALOGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. WILLIAM BALOGH
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:
1417022484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2016 S 320TH ST
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
FEDERAL WAY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98003-5453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-839-1610
Provider Business Mailing Address Fax Number:
253-839-0755

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2016 S 320TH ST
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-5453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-839-1610
Provider Business Practice Location Address Fax Number:
253-839-0755
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURGOS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
253-839-1610

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  O.D.00001030 , 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: WA0006 . This is a "NBN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 3909 . This is a "DAVIS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: BA3096 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 02781 . This is a "SPECTERA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 2052900 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 212835 . This is a "EYEMED" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AETNA . This is a "44132B" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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