Provider Demographics
NPI:1639300395
Name:ALVORD MEDICAL CONSULTANTS PS
Entity Type:Organization
Organization Name:ALVORD MEDICAL CONSULTANTS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:ALVORD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:253-222-2172
Mailing Address - Street 1:2201 S 19TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2961
Mailing Address - Country:US
Mailing Address - Phone:252-222-2172
Mailing Address - Fax:
Practice Address - Street 1:2201 S 19TH ST STE 101
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2961
Practice Address - Country:US
Practice Address - Phone:252-222-2172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00035185261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center