1679144398 NPI number — EVERGREEN PSYCHIATRIC SERVICES, PLLC

Table of content: DR. PRATAP THIRU ARASU MD (NPI 1952319444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679144398 NPI number — EVERGREEN PSYCHIATRIC SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVERGREEN PSYCHIATRIC SERVICES, 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:
1679144398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7001 SEAVIEW AVE NW STE 160-380
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98117-6006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-502-0991
Provider Business Mailing Address Fax Number:
206-326-1012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 7TH AVE STE 2100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98101-1360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-502-0991
Provider Business Practice Location Address Fax Number:
206-326-1012
Provider Enumeration Date:
07/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
MEUNIER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
206-502-0991

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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