1659392090 NPI number — JAMES D KRISEMAN D.O.

Table of content: JAMES D KRISEMAN D.O. (NPI 1659392090)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659392090 NPI number — JAMES D KRISEMAN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRISEMAN
Provider First Name:
JAMES
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1659392090
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3947
Provider Second Line Business Mailing Address:
MS 315010
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-3947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-688-5670
Provider Business Mailing Address Fax Number:
425-453-5139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16315 NE 74TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDMOND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98052-7800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-435-6430
Provider Business Practice Location Address Fax Number:
425-635-6431
Provider Enumeration Date:
07/21/2006

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: 207Q00000X , with the licence number:  OS6356 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: OP60089222 , 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)

  • Identifier: 274573900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2021584 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 298779 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".