1578960415 NPI number — MR. WILLIAM A SUTHERLAND JR. HIS

Table of content: MR. WILLIAM A SUTHERLAND JR. HIS (NPI 1578960415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578960415 NPI number — MR. WILLIAM A SUTHERLAND JR. HIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUTHERLAND
Provider First Name:
WILLIAM
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
HIS
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:
1578960415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15701 E SPRAGUE AVE
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
SPOKANE VALLEY
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99037-5019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-323-9229
Provider Business Mailing Address Fax Number:
509-323-9255

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15701 E SPRAGUE AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99037-5019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-323-9229
Provider Business Practice Location Address Fax Number:
509-323-9255
Provider Enumeration Date:
11/20/2014

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: 237700000X , with the licence number:  HA60471670 , 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)





Copyright © 2007-2025 www.npivalidator.com