Provider Demographics
NPI:1336318088
Name:RICHARD T KUBINIEC MD PS
Entity Type:Organization
Organization Name:RICHARD T KUBINIEC MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:KUBINIEC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-892-0208
Mailing Address - Street 1:PO BOX 820523
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-0011
Mailing Address - Country:US
Mailing Address - Phone:360-892-0208
Mailing Address - Fax:360-892-9081
Practice Address - Street 1:11801 NE 65TH ST
Practice Address - Street 2:#A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-5552
Practice Address - Country:US
Practice Address - Phone:360-892-0208
Practice Address - Fax:360-892-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034433207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1118116Medicaid
OR227404Medicaid
G13181Medicare UPIN