Provider Demographics
NPI:1093001489
Name:GOOD NIGHT MEDICAL OF WASHINGTON, INC.
Entity Type:Organization
Organization Name:GOOD NIGHT MEDICAL OF WASHINGTON, INC.
Other - Org Name:GOOD NIGHT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-499-0776
Mailing Address - Street 1:975 EASTWIND DR
Mailing Address - Street 2:SUITE 165
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5322
Mailing Address - Country:US
Mailing Address - Phone:614-384-7433
Mailing Address - Fax:614-386-0278
Practice Address - Street 1:16515 MERIDIAN E
Practice Address - Street 2:SUITE 203B
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6251
Practice Address - Country:US
Practice Address - Phone:253-517-3680
Practice Address - Fax:614-386-0278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD NIGHT MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-23
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6174840002Medicare NSC