1740568906 NPI number — STEAMBOAT HEALTH & WELLNESS, PLLC

Table of content: (NPI 1740568906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740568906 NPI number — STEAMBOAT HEALTH & WELLNESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEAMBOAT HEALTH & WELLNESS, 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:
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:
1740568906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3403 STEAMBOAT ISLAND RD NW
Provider Second Line Business Mailing Address:
#497
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-4876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-866-6479
Provider Business Mailing Address Fax Number:
360-866-1461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6541 SEXTON DR NW
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
OLYMPIA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98502-9222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-866-6479
Provider Business Practice Location Address Fax Number:
360-866-1461
Provider Enumeration Date:
07/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SHEFFELS
Authorized Official First Name:
HEIDI
Authorized Official Middle Name:
LAURIE
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
360-866-6479

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC60280766 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA00004885 , 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)





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