1679754139 NPI number — BARIATRIC SURGERY CLINIC TRUST

Table of content: (NPI 1679754139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679754139 NPI number — BARIATRIC SURGERY CLINIC TRUST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARIATRIC SURGERY CLINIC TRUST
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:
1679754139
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1560 N 115TH ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98133-8414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-368-1070
Provider Business Mailing Address Fax Number:
206-363-4172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1560 N 115TH ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98133-8414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-368-1070
Provider Business Practice Location Address Fax Number:
206-363-4172
Provider Enumeration Date:
11/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SCHNEIDER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
206-368-1700

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MD00043626 . This is a "MEDIC AL LICENSE" identifier . This identifiers is of the category "OTHER".




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