RONALD J GRAF MD PS - NPI NUMBER 1144408840

Summary

Provider Name: RONALD J GRAF MD PS

NPI Number: 1144408840

Clasification: Clinic/Center (261QM2500X)

Specialization: Medical Specialty

Address:
1901 S CEDAR ST
#205
TACOMA, WA
ZIP 98405

Phone Number: (253) 627-9122



Detailed Information

RONALD J GRAF MD PS is a medical specialty clinic/center in Tacoma, WA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). The assigned NPI number for this provider is 1144408840 and is registered as an organization entity type.

The provider's business address is:

1901 S CEDAR ST
#205
TACOMA, WA
ZIP 98405-308
Phone: (253) 627-9122
Fax: (253) 272-7203

The provider's authorized official is Ronald J Graf .
The authorized official title is President and has the following contact phone number (253) 627-9122.

The enumeration date for this NPI number is 2/5/2008 and was last updated on 2/25/2008.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QM2500X Clinic/Center Medical Specialty MD00013532 WA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 A08421 MEDICARE UPIN WA
2 1395904 MEDICAID WA

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1144408840 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name RONALD J GRAF MD PS The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 1901 S CEDAR ST The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address #205 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name TACOMA The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name WA The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 984052308 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 2536279122 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 2532727203 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 2/5/2008 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 2/25/2008 The date that a record was last updated or changed.
15 Authorized Official Last Name GRAF The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name RONALD The first name of the authorized official.
17 Authorized Official Middle Name J The middle name of the authorized official.
18 Authorized Official Title or Position PRESIDENT The title or position of the authorized official.
19 Authorized Official Telephone Number 2536279122 The 10-position telephone number of the authorized official.
20 Healthcare Provider Taxonomy Code 1 261QM2500X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
21 Provider License Number 1 MD00013532 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
22 Provider License Number State Code 1 WA The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
23 Healthcare Provider Primary Taxonomy Switch 1 Y
24 Other Provider Identifier 1 A08421 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 1 02 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier State 1 WA
27 Other Provider Identifier 2 1395904 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier State 2 WA
30 Is Organization Subpart Y
31 Parent Organization LBN RONALD J GRAF MD PS
32 Parent Organization TIN
33 Authorized Official Name Prefix Text DR.
34 Authorized Official Credential Text M.D.

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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