1477548253 NPI number — CITY OF KENNEWICK

Table of content: (NPI 1477548253)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477548253 NPI number — CITY OF KENNEWICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF KENNEWICK
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:
1477548253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6108
Provider Second Line Business Mailing Address:
210 W 6TH AVE
Provider Business Mailing Address City Name:
KENNEWICK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99336-5649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-585-4379
Provider Business Mailing Address Fax Number:
509-585-4254

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 W 6TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENNEWICK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99336-5649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-585-4379
Provider Business Practice Location Address Fax Number:
505-585-4254
Provider Enumeration Date:
09/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
LYNNE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ACCOUNTING SUPERVISOR
Authorized Official Telephone Number:
509-585-4263

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  03M02 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X , with the licence number: 03M02 , 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: 590004614 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 6153602 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8906318 . This is a "CRIME VICTIMS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 103705 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16689 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9153602 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 16689 . This is a "L&I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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