Provider Demographics
NPI:1801199575
Name:POPE'S KIDS PLACE
Entity Type:Organization
Organization Name:POPE'S KIDS PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-736-9147
Mailing Address - Street 1:230 WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9325
Mailing Address - Country:US
Mailing Address - Phone:360-736-9147
Mailing Address - Fax:
Practice Address - Street 1:230 WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9325
Practice Address - Country:US
Practice Address - Phone:360-736-9147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health