1801819743 NPI number — SHANNON TAYLOR CORRIGAN M.D.

Table of content: SHANNON TAYLOR CORRIGAN M.D. (NPI 1801819743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801819743 NPI number — SHANNON TAYLOR CORRIGAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORRIGAN
Provider First Name:
SHANNON
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1801819743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 24584
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:
98124-0584
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-656-4255
Provider Business Mailing Address Fax Number:
425-656-4003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 S 43RD ST
Provider Second Line Business Practice Location Address:
ER DEPT
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98055-5714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-228-3450
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PE0004X , with the licence number:  MD00041173 , 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: 8317091 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0185268 . This is a "LABOR&IND PROV BILLING #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5532CO . This is a "REGENCE BS PROV #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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