1679681787 NPI number — NORTHERN MEDICAL SYSTEMS, INC.

Table of content: (NPI 1679681787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679681787 NPI number — NORTHERN MEDICAL SYSTEMS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN MEDICAL SYSTEMS, INC.
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:
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:
1679681787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 810
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:
99109-0810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-935-4020
Provider Business Mailing Address Fax Number:
509-935-4975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
332902 HIGHWAY 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99156-5165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-447-5332
Provider Business Practice Location Address Fax Number:
509-447-2814
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLMES
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
509-935-4020

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9055393 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9040809 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9055377 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805398300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7123698 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9055385 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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