1427152826 NPI number — DEPT OF VETERAN AFFAIRS

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 1427152826 NPI number — DEPT OF VETERAN AFFAIRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEPT OF VETERAN AFFAIRS
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:
1427152826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2528 BUKER ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98501-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-870-3668
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PUGET SOUND HC SYSTEM
Provider Second Line Business Practice Location Address:
AMERICAN LAKE DIVISION
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98493-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-583-8448
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
PA-C
Authorized Official Telephone Number:
253-582-8440

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , 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)