Provider Demographics
NPI:1013176676
Name:GOOD NIGHT MEDICAL OF WASHINGTON, INC.
Entity Type:Organization
Organization Name:GOOD NIGHT MEDICAL OF WASHINGTON, INC.
Other - Org Name:GOOD NIGHT MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-499-0776
Mailing Address - Street 1:975 EASTWIND DR
Mailing Address - Street 2:SUITE 165
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-5322
Mailing Address - Country:US
Mailing Address - Phone:614-384-7433
Mailing Address - Fax:614-386-0278
Practice Address - Street 1:12209 E MISSION AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4824
Practice Address - Country:US
Practice Address - Phone:509-465-5522
Practice Address - Fax:614-386-0278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD NIGHT MEDICAL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-08
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADME 9062175Medicaid
WAOXYGEN 9062159Medicaid
WA6174840001Medicare NSC