Provider Demographics
NPI: | 1326093873 |
---|---|
Name: | MULTICARE HEALTH SYSTEM |
Entity type: | Organization |
Organization Name: | MULTICARE HEALTH SYSTEM |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF FINANCIAL OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VINCENT |
Authorized Official - Middle Name: | H |
Authorized Official - Last Name: | SCHMITZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CFO |
Authorized Official - Phone: | 253-459-8000 |
Mailing Address - Street 1: | 315 MARTIN LUTHER KING JR WAY |
Mailing Address - Street 2: | |
Mailing Address - City: | TACOMA |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98405-4234 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-459-8000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 315 MARTIN LUTHER KING JR WAY |
Practice Address - Street 2: | |
Practice Address - City: | TACOMA |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98405-4234 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-459-8000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-23 |
Last Update Date: | 2013-09-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
No | 170100000X | Other Service Providers | Medical Genetics, Ph.D. Medical Genetics | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 231H00000X | Speech, Language and Hearing Service Providers | Audiologist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WA | 7064819 | Medicaid | |
WA | 7059298 | Medicaid | |
WA | 45941 | Other | STATE L&I |
WA | 115104500 | Medicare PIN |