1447304449 NPI number — NORTH KITSAP FAMILY PRACTICE AND URGENT CARE P.S.

Table of content: (NPI 1447304449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447304449 NPI number — NORTH KITSAP FAMILY PRACTICE AND URGENT CARE P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH KITSAP FAMILY PRACTICE AND URGENT CARE P.S.
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:
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:
1447304449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20730 BOND RD NE STE 205
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POULSBO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98370-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-697-1957
Provider Business Mailing Address Fax Number:
360-779-9224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20730 BOND RD NE STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-697-1957
Provider Business Practice Location Address Fax Number:
360-779-9224
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BETHEL
Authorized Official First Name:
JODENE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CLINIC ADMINISTRATOR
Authorized Official Telephone Number:
360-697-1957

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CB3969 . This is a "RAILROAD MEDICARE PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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