1437348570 NPI number — MR. THOMAS D MEYER LMP, CCSP

Table of content: MR. THOMAS D MEYER LMP, CCSP (NPI 1437348570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437348570 NPI number — MR. THOMAS D MEYER LMP, CCSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEYER
Provider First Name:
THOMAS
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMP, CCSP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1437348570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 854
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
QUILCENE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98376-0854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-301-1663
Provider Business Mailing Address Fax Number:
360-765-3655

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1054 RIPLEY CREEK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUILCENE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-301-1663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/15/2007

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: 225700000X , with the licence number:  MA00015460 , 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: MA00015460 . This is a "STATE OF WASHINGTON" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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