1558545772 NPI number — JOSEPH M MCCREERY MD PLLC

Table of content: (NPI 1558545772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558545772 NPI number — JOSEPH M MCCREERY MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH M MCCREERY MD PLLC
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:
1558545772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 21405
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98111-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-774-0532
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4026 NE 55TH ST
Provider Second Line Business Practice Location Address:
STE E200
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98105-2262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-344-2505
Provider Business Practice Location Address Fax Number:
206-306-0302
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCREERY
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
206-344-2505

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  MD00021272 , 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)





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