Provider Demographics
NPI:1336194869
Name:CAPRI HEART & LUNG INSTITUTE
Entity Type:Organization
Organization Name:CAPRI HEART & LUNG INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:HUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-479-3886
Mailing Address - Street 1:2601 CHERRY AVE
Mailing Address - Street 2:#111
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4203
Mailing Address - Country:US
Mailing Address - Phone:360-479-3886
Mailing Address - Fax:360-479-0671
Practice Address - Street 1:2601 CHERRY AVE
Practice Address - Street 2:#111
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4203
Practice Address - Country:US
Practice Address - Phone:360-479-3886
Practice Address - Fax:360-479-0671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA582251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7069271Medicaid
GAB00872Medicare PIN
WAE34988Medicare UPIN