Provider Demographics
NPI:1881652147
Name:KITSAP CARDIOLOGY CONSULTANTS, P.L.L.C.
Entity Type:Organization
Organization Name:KITSAP CARDIOLOGY CONSULTANTS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:BERGLIND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-373-2547
Mailing Address - Street 1:2709 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2623
Mailing Address - Country:US
Mailing Address - Phone:360-373-2547
Mailing Address - Fax:360-479-8268
Practice Address - Street 1:2709 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-2623
Practice Address - Country:US
Practice Address - Phone:360-373-2547
Practice Address - Fax:360-479-8268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7068836Medicaid