1801226758 NPI number — NORTHWEST ASTHMA ALLERGY CENTER

Table of content: (NPI 1801226758)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801226758 NPI number — NORTHWEST ASTHMA ALLERGY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHWEST ASTHMA ALLERGY CENTER
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:
ALLERGY & ASTHMA CENTERS OF THE NW
Provider Other Organization Name Type Code:
3
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:
1801226758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 821046
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98682-0024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-896-2222
Provider Business Mailing Address Fax Number:
360-896-8881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8625 SW CASCADE AVE
Provider Second Line Business Practice Location Address:
#510
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97008-7121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-257-3555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
CASSIE
Authorized Official Middle Name:
Authorized Official Title or Position:
RECEPTIONIST
Authorized Official Telephone Number:
360-896-2222

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD24825 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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