1679537575 NPI number — NEW HEALTH PROGRAMS ASSOCIATION

Table of content: (NPI 1679537575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679537575 NPI number — NEW HEALTH PROGRAMS ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW HEALTH PROGRAMS ASSOCIATION
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:
NEW HEALTH CHEWELAH MEDICAL
Provider Other Organization Name Type Code:
3
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:
1679537575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 808
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEWELAH
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99109-0808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-935-6001
Provider Business Mailing Address Fax Number:
509-935-4196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
518 E CLAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHEWELAH
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99109-8947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-935-8424
Provider Business Practice Location Address Fax Number:
509-935-8402
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POE
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
509-935-6001

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  J600317870 , 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: 7069982 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80300 . This is a "LABOR AND INDUSTRIES ID" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7034093 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CE9078 . This is a "RR MEDICARE PIN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com