=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447546809
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | XPIO GROUP HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2011
-----------------------------------------------------
Last Update Date | 06/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8903 KEY PENINSULA HWY N
-----------------------------------------------------
City | LAKEBAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98349-9326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-651-7482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8903 KEY PENINSULA HWY N
-----------------------------------------------------
City | LAKEBAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98349-9326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-651-7482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | THAD DICKSON
-----------------------------------------------------
Credential | CPHIMS, PMP
-----------------------------------------------------
Telephone | 253-651-7482
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246Z00000X
-----------------------------------------------------
Taxonomy Name | Other Specialist/Technologist
-----------------------------------------------------
License Number | CPHIMS - 1592
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------