Provider Demographics
NPI:1376761528
Name:HEALTH CARE SUPPLY
Entity Type:Organization
Organization Name:HEALTH CARE SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-676-8707
Mailing Address - Street 1:1701 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4604
Mailing Address - Country:US
Mailing Address - Phone:360-676-8707
Mailing Address - Fax:360-676-8707
Practice Address - Street 1:1701 N STATE ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4604
Practice Address - Country:US
Practice Address - Phone:360-676-8707
Practice Address - Fax:360-676-8707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600050758332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0013349OtherWA STATE L&I PIN
WA9142308Medicaid
WAHE1469OtherREGENCE BLUE SHIELD PIN
WA103961001OtherGROUP HEALTH PIN
WA9008632Medicaid
WA103961001OtherGROUP HEALTH PIN
WA9142308Medicaid