|Provider Name||PROV CENTRLIA INTERNAL MEDICINE (PROVIDENCE HEALTH & SERVICE - WASHINGTON)|
|Provider Location Address||2015 COOKS HILL RD SUITE 200 CENTRALIA, WA 98531|
|Provider Mailing Address||PO BOX 34439 SEATTLE, WA 98124|
|NPI Entity Type||Organization|
|Is Sole Proprietor?||N/A|
|Is Organization Subpart?||No|
|Other Organization Name||PROV CENTRLIA INTERNAL MEDICINE|
|Other Name Type||Doing Business As (3)|
|Last Update Date||12-22-2010|
PROV CENTRLIA INTERNAL MEDICINE
2015 COOKS HILL RD
Phone: (360) 330-8939
Fax: (360) 330-8916
PROV CENTRLIA INTERNAL MEDICINE
PO BOX 34439
Phone: (425) 525-6778
Fax: (425) 525-6700
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:
|Facility Type||PHYSICIAN OFFICE|
|Certificate Type||Certificate of Accreditation|
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 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|
|G8869645||MEDICARE PIN (08)||WA|
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
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.
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
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)
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.
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.
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.
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.