Provider Demographics
NPI:1104056159
Name:COLETTE M KATO PLLC
Entity type:Organization
Organization Name:COLETTE M KATO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-532-1800
Mailing Address - Street 1:1220 BASICH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-1034
Mailing Address - Country:US
Mailing Address - Phone:360-532-1800
Mailing Address - Fax:360-532-2658
Practice Address - Street 1:1220 BASICH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1034
Practice Address - Country:US
Practice Address - Phone:360-532-1800
Practice Address - Fax:360-532-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE34243Medicare UPIN