Provider Demographics
NPI:1386829406
Name:CECIL E SNODGRASS M.D. INC PS
Entity Type:Organization
Organization Name:CECIL E SNODGRASS M.D. INC PS
Other - Org Name:VIEW POINT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-770-3939
Mailing Address - Street 1:1409 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-3706
Mailing Address - Country:US
Mailing Address - Phone:253-770-3939
Mailing Address - Fax:253-770-9982
Practice Address - Street 1:1409 2ND ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3706
Practice Address - Country:US
Practice Address - Phone:253-770-3939
Practice Address - Fax:253-770-9982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015382305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1517101Medicaid
WAGAB36175Medicare UPIN
WAGAB36175Medicare PIN
WAG8876929Medicare UPIN
WAQ26351Medicare UPIN
WAP00121006Medicare UPIN
WAA08900Medicare UPIN
WAE34651Medicare UPIN
WA1517101Medicaid