1558810812 NPI number — U.S. HEALTHWORKS MEDICAL GROUP OF WASHINGTON, PS

Table of content: (NPI 1558810812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558810812 NPI number — U.S. HEALTHWORKS MEDICAL GROUP OF WASHINGTON, PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
U.S. HEALTHWORKS MEDICAL GROUP OF WASHINGTON, PS
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:
1558810812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25124 SPRINGFIELD CT
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
VALENCIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91355-1085
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-678-2600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 111TH ST SW
Provider Second Line Business Practice Location Address:
UNIT #T/U
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98204-3590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-267-0299
Provider Business Practice Location Address Fax Number:
425-513-1446
Provider Enumeration Date:
09/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MALLAS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
T
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
661-678-2600

Provider Taxonomy Codes

  • Taxonomy code: 2083X0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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