NPIMap

Organization Active NPI

Eagle Sweep Integrative Internal Medicine Incorporated

  • Internal Medicine Physician
  • Bremerton, WA
National Provider Identifier
1780906255
Registry record updated Jun 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD00030507 Issued in WA
Legal business name
EAGLE SWEEP INTEGRATIVE INTERNAL MEDICINE INCORPORATED
Practice address
3036 Perry Ave
Suite a
Bremerton, WA 98310-5349
Phone
(360) 627-8493
Fax
(360) 627-7920
NPI assigned
Feb 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2012

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

Authorized official

Name
Dr. Tavis Taylor, M.D.
Title
President
Phone
(360) 627-8493

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MD00030507 WA Primary

Addresses

Primary practice location

3036 Perry Ave
Suite a
Bremerton, WA 98310-5349

Mailing address

3036 Perry Ave
Suite a
Bremerton, WA 98310-5349
Phone (360) 627-8493

National Provider Directory

National Provider Directory

Locations

3036 Perry Ave
Ste A
Bremerton, WA 98310
Phone (360) 627-8493

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": "1266969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339545600000",
    "number": "1780906255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3036 PERRY AVE",
            "address_2": "SUITE A",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983105349",
            "telephone_number": "360-627-8493",
            "fax_number": "360-627-7920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3036 PERRY AVE",
            "address_2": "SUITE A",
            "city": "BREMERTON",
            "state": "WA",
            "postal_code": "983105349",
            "telephone_number": "360-627-8493",
            "fax_number": "360-627-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE SWEEP INTEGRATIVE INTERNAL MEDICINE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-24",
        "last_updated": "2012-06-13",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "TAVIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-627-8493",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00030507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bremerton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.