1639346364 NPI number — SOUTH SOUND INPATIENT PHYSICIANS PLLC

Table of content: (NPI 1639346364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639346364 NPI number — SOUTH SOUND INPATIENT PHYSICIANS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH SOUND INPATIENT PHYSICIANS 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:
6
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:
1639346364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60000
Provider Second Line Business Mailing Address:
FILE 31045
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94160-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-529-9724
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
914 S SCHEUBER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTRALIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98531-9027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-736-2803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KODJABABIAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
253-682-1710

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7108889 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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