1548391964 NPI number — FAMILY PLANNING OF CLALLAM COUNTY

Table of content: (NPI 1548391964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548391964 NPI number — FAMILY PLANNING OF CLALLAM COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PLANNING OF CLALLAM COUNTY
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:
1548391964
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 927
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ANGELES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98362-0160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-452-2954
Provider Business Mailing Address Fax Number:
360-457-7683

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1106 E 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ANGELES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98362-4317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-452-2954
Provider Business Practice Location Address Fax Number:
360-457-7683
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REEVES SPERR
Authorized Official First Name:
CHERIE
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
360-452-2954

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  600258997000 , 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: 7921109 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: AB39834 . This is a "MEDICARE ID#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AB39835 . This is a "MEDICARE ID#" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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