1922312149 NPI number — DR. RICHARD BARRETT KING ED.D.

Table of content: DR. RICHARD BARRETT KING ED.D. (NPI 1922312149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922312149 NPI number — DR. RICHARD BARRETT KING ED.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
RICHARD
Provider Middle Name:
BARRETT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.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:
1922312149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYLHURST
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-657-0683
Provider Business Mailing Address Fax Number:
503-557-0579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19890 ROAN CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LINN
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-657-0683
Provider Business Practice Location Address Fax Number:
503-557-0579
Provider Enumeration Date:
07/29/2010

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: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 121850 . This is a "DHS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 2002 . This is a "NCC" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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