1801050786 NPI number — EMERALD CENTER FOR INTEGRATIVE MEDICINE LLC

Table of content: MISS CARRIE LYNETTE MILLER P.C.C. (NPI 1447569876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801050786 NPI number — EMERALD CENTER FOR INTEGRATIVE MEDICINE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMERALD CENTER FOR INTEGRATIVE MEDICINE LLC
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:
1801050786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 78193
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98178-0193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-772-5315
Provider Business Mailing Address Fax Number:
206-774-8751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9730 3RD AVE NE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98115-2023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-525-5576
Provider Business Practice Location Address Fax Number:
206-525-5776
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FITZPATRICK
Authorized Official First Name:
MOIRA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER / PHYSICIAN
Authorized Official Telephone Number:
206-525-5576

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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