Provider Demographics
NPI:1295873578
Name:DAN E RANNIGER MD PS INC
Entity type:Organization
Organization Name:DAN E RANNIGER MD PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:RANNIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-854-9570
Mailing Address - Street 1:13210 SE 240TH ST
Mailing Address - Street 2:A6
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5182
Mailing Address - Country:US
Mailing Address - Phone:253-854-9570
Mailing Address - Fax:253-854-3478
Practice Address - Street 1:13210 SE 240TH ST
Practice Address - Street 2:A6
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5182
Practice Address - Country:US
Practice Address - Phone:253-854-9570
Practice Address - Fax:253-854-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00005641173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1705300Medicaid
WA1705300Medicaid