PROV CENTRLIA INTERNAL MEDICINE (PROVIDENCE HEALTH & SERVICE - WASHINGTON) NPI 1003009259

Internal Medicine (Medical Oncology) in Centralia, WA

NPI 1003009259 Organization Internal Medicine Medical Oncology CLIA Number 50D0969731 CLIA Certificate of Accreditation

About PROV CENTRLIA INTERNAL MEDICINE (PROVIDENCE HEALTH & SERVICE - WASHINGTON)

Prov Centrlia Internal Medicine (providence Health & Service - Washington) is an internal medicine provider established in Centralia, Washington specializing in internal medicine (medical oncology) . The NPI number of Prov Centrlia Internal Medicine (providence Health & Service - Washington) is 1003009259 and was assigned on August 2007. The practitioner's primary taxonomy code is 207RX0202X. The provider is registered as an organization and their NPI record was last updated 11 years ago. Prov Centrlia Internal Medicine (providence Health & Service - Washington) operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The provider's is doing business as Prov Centrlia Internal Medicine. The authorized official of this NPI record is Nicole Quinn (Payor Credentialing Manager)

An internist like Prov Centrlia Internal Medicine is a physician who has completed an internal medicine residency and is board-certified or board-eligible in an internist specialty. Internists are trained to care for adults of all ages for many different medical conditions. An internist typically monitors chronic physical conditions, identifies acute diseases, provides family planning, provides counseling about wellness and disease prevention, etc.

The CLIA number of Prov Centrlia Internal Medicine is 50D0969731 registered as a "physician office" facility with a CLIA Certificate of Accreditation. This is a CLIA certificate is issued to Prov Centrlia Internal Medicine on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.

NPI

1003009259

Provider NamePROV CENTRLIA INTERNAL MEDICINE (PROVIDENCE HEALTH & SERVICE - WASHINGTON)
Provider Location Address2015 COOKS HILL RD SUITE 200 CENTRALIA, WA 98531
Provider Mailing AddressPO BOX 34439 SEATTLE, WA 98124
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NamePROV CENTRLIA INTERNAL MEDICINE
Other Name TypeDoing Business As (3)
Enumeration Date08-21-2007
Last Update Date12-22-2010


Primary Taxonomy

Taxonomy Code207RX0202X
ClassificationInternal Medicine
TypeAllopathic & Osteopathic Physicians
SpecializationMedical Oncology
Taxonomy DescriptionAn internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer.

Business Address

PROV CENTRLIA INTERNAL MEDICINE
2015 COOKS HILL RD
SUITE 200
CENTRALIA, WA
ZIP 98531
Phone: (360) 330-8939
Fax: (360) 330-8916

Get Directions


Mailing Address

PROV CENTRLIA INTERNAL MEDICINE
PO BOX 34439
SEATTLE, WA
ZIP 98124
Phone: (425) 525-6778
Fax: (425) 525-6700



Authorized Official

Authorized Official Name NICOLE QUINN
Authorized Official TitlePAYOR CREDENTIALING MANAGER
Authorized Official Phone(425) 525-6715

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1003009259 is:

CLIA Number50D0969731
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Accreditation

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
7139785MEDICAID (05)WA
G8869645MEDICARE PIN (08)WA

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.