1578000576 NPI number — FRANCIS A TOOTELL RN

Table of content: FRANCIS A TOOTELL RN (NPI 1578000576)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578000576 NPI number — FRANCIS A TOOTELL RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOOTELL
Provider First Name:
FRANCIS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOOTELL
Provider Other First Name:
FRANK
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578000576
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1776 SW MADISON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97205-1715
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-224-1044
Provider Business Mailing Address Fax Number:
503-224-4494

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
703 NE HANCOCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97212-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-230-9875
Provider Business Practice Location Address Fax Number:
503-230-9877
Provider Enumeration Date:
01/27/2017

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: 163W00000X , with the licence number:  RN00123953 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 201606748RN , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2075159 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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