1972698157 NPI number — SCHOOL DIST #201

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972698157 NPI number — SCHOOL DIST #201

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHOOL DIST #201
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:
6
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:
1972698157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1110 S 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNNYSIDE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98944-2197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-836-8426
Provider Business Mailing Address Fax Number:
509-836-5591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 S 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98944-2197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-836-8426
Provider Business Practice Location Address Fax Number:
509-836-5591
Provider Enumeration Date:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WATTS
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
509-836-8709

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , 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: 7440985 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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