NPIMap

Organization Active NPI

Mark W Bradford MD Inc PS

  • Clinic/Center
  • Olympia, WA
National Provider Identifier
1619241346
Registry record updated Feb 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
MD0019897 Issued in WA
Legal business name
MARK W BRADFORD MD INC PS
Practice address
3624 Ensign Rd NE Ste D
Olympia, WA 98506-5074
Phone
(360) 459-7713
Fax
(360) 459-5441
NPI assigned
Feb 27, 2012
Last updated
Feb 27, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2012

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

Authorized official

Name
Mark Wayne Bradford, MDNPI 1548335938
Title
President
Phone
(360) 459-7713

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MD0019897 WA Primary

Addresses

Primary practice location

3624 Ensign Rd NE Ste D
Olympia, WA 98506-5074

Mailing address

3624 Ensign Rd NE Ste D
Olympia, WA 98506-5074
Phone (360) 459-7713

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1330300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330300800000",
    "number": "1619241346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE STE D",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-459-7713",
            "fax_number": "360-459-5441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3624 ENSIGN RD NE STE D",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065074",
            "telephone_number": "360-459-7713",
            "fax_number": "360-459-5441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK W BRADFORD MD INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-27",
        "last_updated": "2012-02-27",
        "status": "A",
        "authorized_official_last_name": "BRADFORD",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-459-7713",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "MD0019897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Feb 27, 2012; 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.