Healthcare Provider Details

I. General information

NPI: 1497785315
Provider Name (Legal Business Name): PLATEAU EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 BATTERSBY AVE EMERGENCY DEPARTMENT
ENUMCLAW WA
98022-3634
US

IV. Provider business mailing address

PO BOX 7720
PHILADELPHIA PA
19101-7720
US

V. Phone/Fax

Practice location:
  • Phone: 360-825-2505
  • Fax:
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7127384
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: DR. CHARLES T. MITCHELL
Title or Position: PRESIDENT
Credential: MD
Phone: 800-444-7009