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General NPI Number Information
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NPI Number | 1992994560
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Entity Type | Organization
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Legal Business Name | SEAHAWK EMERGENCY PHYSICIANS
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 07/24/2009
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Provider Practice Location Address
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Address Line | 502 W 4TH AVE
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City | TOPPENISH
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State | WA
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Zip | 98948-1616
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Country | US
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Telephone | 509-865-3105
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37701
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City | PHILADELPHIA
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State | PA
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Zip | 19101-5001
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Country | US
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Telephone | 805-563-3010
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Fax | 805-564-5087
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | CHARLES T MITCHELL
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Credential | MD
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Telephone | 805-563-3010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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