NPIMap

Organization Active NPI

Virginia R Cannon MD PLLC

  • Adolescent Medicine (Internal Medicine) Physician
  • Olympia, WA
National Provider Identifier
1144402009
Registry record updated Oct 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
Legal business name
VIRGINIA R CANNON MD PLLC
Practice address
406 Yauger Way SW
Suite a
Olympia, WA 98502-8151
Phone
(360) 352-3232
Fax
(360) 352-2942
NPI assigned
Dec 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Virginia R Cannon, M.D,NPI 1609971365
Title
Owner
Phone
(360) 352-3232

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RA0000X Primary

Addresses

Primary practice location

406 Yauger Way SW
Suite a
Olympia, WA 98502-8151

Mailing address

406 Yauger Way SW
Suite a
Olympia, WA 98502-8151
Phone (360) 352-3232

Other identifiers 1

IdentifierTypeStateIssuer
117480MedicaidWA

Other names 1

  • West Olympia Bone Density Center Doing business as

National Provider Directory

National Provider Directory

Locations

406 Yauger Way SW
Ste A
Olympia, WA 98502
Phone (360) 352-2909

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196640000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288310400000",
    "number": "1144402009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 YAUGER WAY SW",
            "address_2": "SUITE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028151",
            "telephone_number": "360-352-3232",
            "fax_number": "360-352-2942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 YAUGER WAY SW",
            "address_2": "SUITE A",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985028151",
            "telephone_number": "360-352-3232",
            "fax_number": "360-352-2942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIRGINIA R CANNON MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-03",
        "last_updated": "2010-10-29",
        "status": "A",
        "authorized_official_last_name": "CANNON",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-352-3232",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D,"
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "117480",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Olympia Bone Density Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.