Organization Active NPI

MV-Anesthesia PS

  • Anesthesiology Physician
  • Mount Vernon, WA
National Provider Identifier
1154457281
Registry record updated Jun 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD00033163 Issued in WA
Legal business name
MV-ANESTHESIA PS
Practice address
110 N 30TH St
Mount Vernon, WA 98273-3668
Phone
(360) 434-3009
Fax
(360) 895-5380
NPI assigned
Feb 25, 2007
Last updated
Jun 26, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2008

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

Authorized official

Name
Terrilynn Nicklin
Title
Billing Manager
Phone
(360) 434-3009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD00033163 WA Primary

Addresses

Primary practice location

110 N 30TH St
Mount Vernon, WA 98273-3668

Mailing address

PO Box 11810
Bainbridge Island, WA 98110-5810
Phone (360) 434-3009

Other identifiers 2

IdentifierTypeStateIssuer
0196474OtherWAL&I
1577DOOtherWAREGENCE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214438400000",
    "number": "1154457281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11810",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981105810",
            "telephone_number": "360-434-3009",
            "fax_number": "360-895-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N 30TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982733668",
            "telephone_number": "360-434-3009",
            "fax_number": "360-895-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MV-ANESTHESIA PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-25",
        "last_updated": "2008-06-26",
        "status": "A",
        "authorized_official_last_name": "NICKLIN",
        "authorized_official_first_name": "TERRILYNN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "360-434-3009"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD00033163",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0196474",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "1577DO",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; 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.