=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578271573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDICAL EVALUATION SPECIALISTS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2022
-----------------------------------------------------
Last Update Date | 11/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 S 336TH ST STE 150
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-733-5615
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 S 336TH ST STE 150
-----------------------------------------------------
City | FEDERAL WAY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98003-5946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-733-5215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP, COMPLIANCE
-----------------------------------------------------
Name | MS. CRYSTAL C CARVOTTA-BROWN
-----------------------------------------------------
Credential | ESQ, RN
-----------------------------------------------------
Telephone | 339-987-9106
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------