Provider Demographics
NPI:1891850418
Name:PAKC DSL INC PS
Entity Type:Organization
Organization Name:PAKC DSL INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:O
Authorized Official - Last Name:HALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-792-6736
Mailing Address - Street 1:PO BOX 2171
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-0368
Mailing Address - Country:US
Mailing Address - Phone:360-271-7274
Mailing Address - Fax:360-479-7018
Practice Address - Street 1:2520 CHERRY AVE
Practice Address - Street 2:PATHOLOGY DEPT HARRISON MEDICAL CENTER
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310
Practice Address - Country:US
Practice Address - Phone:360-744-6731
Practice Address - Fax:360-744-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7107287Medicaid
WA9109177600OtherKPS
WAKI0446OtherREGENCE
WA154370OtherLABOR & INDUSTRIES
WA022905001OtherGROUP HEALTH
WA9109177600OtherKPS
WA=========98310A001OtherTRICARE