1659439966 NPI number — MR. JOHN FORE M.S.P.T.

Table of content: MR. JOHN FORE M.S.P.T. (NPI 1659439966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659439966 NPI number — MR. JOHN FORE M.S.P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORE
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S.P.T.
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:
1659439966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17414 NE 14TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLEVUE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98008-3105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12121 NORTHUP WAY
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98005-1928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-895-8436
Provider Business Practice Location Address Fax Number:
425-895-8110
Provider Enumeration Date:
12/06/2006

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: 225100000X , with the licence number:  PT00009071 , 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: 3120217 . This is a "AETNA (HMO, QPOS, US)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8378671 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0168404 . This is a "LABOR AND INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7561142 . This is a "AETNA (PPO, POS, EPO)" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 11362195 . This is a "FIRST HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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