Active NPI
MV-Anesthesia PS
- Anesthesiology Physician
- Mount Vernon, WA
National Provider Identifier
1154457281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD00033163
- 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, 2008
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0196474 | Other | WA | L&I |
| 1577DO | Other | WA | REGENCE |
National Provider Directory
National Provider DirectoryPractitioners & 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.
-
- Anesthesiology Physician
- Gig Harbor, WA
- NPI 1689684649
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.