1942470232 NPI number — PACIFIC MEDICAL REHABILITATION, PLLC

Table of content: (NPI 1942470232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942470232 NPI number — PACIFIC MEDICAL REHABILITATION, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC MEDICAL REHABILITATION, PLLC
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:
1942470232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30676
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98228-2676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-543-5250
Provider Business Mailing Address Fax Number:
360-543-5251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4540 CORDATA PKWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BELLINGHAM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98226-8059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-543-5250
Provider Business Practice Location Address Fax Number:
360-543-5251
Provider Enumeration Date:
03/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CUI
Authorized Official First Name:
JIMMY
Authorized Official Middle Name:
YI
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
360-543-5250

Provider Taxonomy Codes

  • Taxonomy code: 261QM2500X , with the licence number:  MD00039814 , 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: 8288169 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com