Provider Demographics
NPI:1932159407
Name:RICHMOND INTERNAL MEDICINE, P.S.
Entity Type:Organization
Organization Name:RICHMOND INTERNAL MEDICINE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-546-5181
Mailing Address - Street 1:355 NW RICHMOND BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-3101
Mailing Address - Country:US
Mailing Address - Phone:206-546-5181
Mailing Address - Fax:206-546-6575
Practice Address - Street 1:355 NW RICHMOND BEACH RD
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98177-3101
Practice Address - Country:US
Practice Address - Phone:206-546-5181
Practice Address - Fax:206-546-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7073752Medicaid
WADE7285OtherRAILROAD MEDICARE
WADE7285OtherRAILROAD MEDICARE