Provider Demographics
NPI:1033130745
Name:KITSAP CHEST CONSULTANTS PLLC
Entity Type:Organization
Organization Name:KITSAP CHEST CONSULTANTS PLLC
Other - Org Name:KITSAP CRITICAL CARE, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRIFFITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-479-8057
Mailing Address - Street 1:1225 CAMPBELL WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3323
Mailing Address - Country:US
Mailing Address - Phone:360-479-8057
Mailing Address - Fax:360-479-0108
Practice Address - Street 1:1225 CAMPBELL WAY STE 201
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3323
Practice Address - Country:US
Practice Address - Phone:360-479-8057
Practice Address - Fax:360-479-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602542295174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF54698Medicare UPIN
WAF75056Medicare UPIN
8864705Medicare PIN
WA8864708Medicare PIN