1558401398 NPI number — DR. DARIAN JERALD VANGORKUM DPM

Table of content: DR. ALBERT H BELFIE DO (NPI 1144268194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558401398 NPI number — DR. DARIAN JERALD VANGORKUM DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANGORKUM
Provider First Name:
DARIAN
Provider Middle Name:
JERALD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1558401398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
925 STEVENS DR
Provider Second Line Business Mailing Address:
STE 2D
Provider Business Mailing Address City Name:
RICHLAND
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99352-3523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-946-7602
Provider Business Mailing Address Fax Number:
509-943-9389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 SWIFT BLVD
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
RICHLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-946-7602
Provider Business Practice Location Address Fax Number:
509-943-9389
Provider Enumeration Date:
02/08/2007

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: 213E00000X , with the licence number:  PO00000620 , 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: 0480830001 . This is a "DEMERC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1104231 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 122647 . This is a "L AND I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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