1891850418 NPI number — PAKC DSL INC PS

Table of content: (NPI 1891850418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891850418 NPI number — PAKC DSL INC PS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAKC DSL 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:
1891850418
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2171
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98310-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-271-7274
Provider Business Mailing Address Fax Number:
360-479-7018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 CHERRY AVE
Provider Second Line Business Practice Location Address:
PATHOLOGY DEPT HARRISON MEDICAL CENTER
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-744-6731
Provider Business Practice Location Address Fax Number:
360-744-6561
Provider Enumeration Date:
12/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HALLMAN
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-792-6736

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7107287 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9109177600 . This is a "KPS" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: KI0446 . This is a "REGENCE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 154370 . This is a "LABOR & INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 022905001 . This is a "GROUP HEALTH" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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