Provider Demographics
NPI:1558674093
Name:PAUL A. ZAVERUHA, MD, PS., INC.
Entity Type:Organization
Organization Name:PAUL A. ZAVERUHA, MD, PS., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:E
Authorized Official - Last Name:HILKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-678-6433
Mailing Address - Street 1:PO BOX 1080
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-1080
Mailing Address - Country:US
Mailing Address - Phone:360-678-6433
Mailing Address - Fax:360-678-6812
Practice Address - Street 1:101 NE BIRCH ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3133
Practice Address - Country:US
Practice Address - Phone:360-678-6433
Practice Address - Fax:360-678-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00019657174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8893296OtherPTAN
WA1001437Medicaid