1740729987 NPI number — WAATU, INC.

Table of content: (NPI 1740729987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740729987 NPI number — WAATU, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WAATU, 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:
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:
1740729987
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1105 27TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANACORTES
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98221-2710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-293-3174
Provider Business Mailing Address Fax Number:
360-293-4418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 21ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANACORTES
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98221-2513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-293-7222
Provider Business Practice Location Address Fax Number:
360-293-7281
Provider Enumeration Date:
02/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KIEFER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
VP CFO
Authorized Official Telephone Number:
360-293-3174

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1313 , 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: 4113130 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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