1487798997 NPI number — O'LEARY, WALSH, AND GEORGE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487798997 NPI number — O'LEARY, WALSH, AND GEORGE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
O'LEARY, WALSH, AND GEORGE INC
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:
1487798997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19101 36TH AVE W
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
LYNNWOOD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036-5759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-771-9300
Provider Business Mailing Address Fax Number:
425-771-8266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19101 36TH AVE W
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
LYNNWOOD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98036-5759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-771-9300
Provider Business Practice Location Address Fax Number:
425-771-8266
Provider Enumeration Date:
02/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GEORGE
Authorized Official First Name:
CYNTHIA GEORGE
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
425-771-9300

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , 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: 7075294 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 601358265 . This is a "WA STATE BUSINESS LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 118088 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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