1467011122 NPI number — WASHINGTON GASTROENTEROLOGY PLLC

Table of content: (NPI 1467011122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467011122 NPI number — WASHINGTON GASTROENTEROLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WASHINGTON GASTROENTEROLOGY PLLC
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:
WASHINGTON GASTROENTEROLOGY LAB
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:
1467011122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3006
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98401-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-734-6855
Provider Business Mailing Address Fax Number:
253-404-0506

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33915 1ST WAY S STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FEDERAL WAY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98003-6396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-838-9839
Provider Business Practice Location Address Fax Number:
253-661-9077
Provider Enumeration Date:
06/06/2019

Additional Information

Authorized Official

Authorized Official Last Name:
GORALSKY
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
253-383-8342

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com