Provider Demographics
NPI:1245656883
Name:ACHEBE MD PS
Entity type:Organization
Organization Name:ACHEBE MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:J
Authorized Official - Last Name:ACHEBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-239-9515
Mailing Address - Street 1:2103 HARRISON AVE NW
Mailing Address - Street 2:#2616
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2636
Mailing Address - Country:US
Mailing Address - Phone:360-239-9515
Mailing Address - Fax:
Practice Address - Street 1:1016 TACOMA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2263
Practice Address - Country:US
Practice Address - Phone:509-837-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty