1467574863 NPI number — DR. MARK URMANSKI M.D

Table of content: DR. MARK URMANSKI M.D (NPI 1467574863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467574863 NPI number — DR. MARK URMANSKI M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
URMANSKI
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
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:
1467574863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 MARTIN WAY E
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98506-5052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-923-5565
Provider Business Mailing Address Fax Number:
360-923-5643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 MARTIN WAY E
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98506-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-923-5565
Provider Business Practice Location Address Fax Number:
360-923-5643
Provider Enumeration Date:
04/04/2007

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: 207PE0004X , with the licence number:  11450 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: AU11450 , 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: 930052468 . This is a "RRN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 114326 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: UR6557 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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