1801115191 NPI number — DAVID O. SCHORES OD INC PS

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 1801115191 NPI number — DAVID O. SCHORES OD INC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVID O. SCHORES OD INC PS
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:
1801115191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 CHIMACUM ROAD
Provider Second Line Business Mailing Address:
PO BOX 357
Provider Business Mailing Address City Name:
PORT HADLOCK
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98339-9774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-385-1093
Provider Business Mailing Address Fax Number:
360-385-6843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 CHIMACUM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HADLOCK
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98339-9774
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-385-1093
Provider Business Practice Location Address Fax Number:
360-385-6843
Provider Enumeration Date:
05/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
SAM
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTS MGR
Authorized Official Telephone Number:
360-385-1093

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OD00001571 , 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: 1467542985 . This is a "RENDERING PROVIDER NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: DQ2827 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: G8891340 . This is a "RENDERING PROVIDER PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1801115191 . This is a "BILLING PROVIDER NPI" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1011175 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G000200362 . This is a "BILLING PROVIDER PTAN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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