1730208026 NPI number — NORTH KITSAP PEDIATRICS P.S.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730208026 NPI number — NORTH KITSAP PEDIATRICS P.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH KITSAP PEDIATRICS P.S.
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:
1730208026
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20730 BOND RD NE
Provider Second Line Business Mailing Address:
#208
Provider Business Mailing Address City Name:
POULSBO
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98370-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-779-7337
Provider Business Mailing Address Fax Number:
360-779-7054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20730 BOND RD NE
Provider Second Line Business Practice Location Address:
#208
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-779-7337
Provider Business Practice Location Address Fax Number:
360-779-7054
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
BERNIE
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
360-779-7337

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OP00000700 , 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: 1072347 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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