Provider Demographics
NPI:1528278553
Name:CURTIS D. REINKE, MD, PS
Entity type:Organization
Organization Name:CURTIS D. REINKE, MD, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:REINKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-956-1725
Mailing Address - Street 1:405 BLACK HILLS LN SW STE C
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8661
Mailing Address - Country:US
Mailing Address - Phone:360-956-1725
Mailing Address - Fax:360-705-2557
Practice Address - Street 1:405 BLACK HILLS LN SW STE C
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8661
Practice Address - Country:US
Practice Address - Phone:360-956-1725
Practice Address - Fax:360-705-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1106814Medicaid
WA126766OtherLABOR & INDUSTRIES
WA=========OtherEIN #
WA1106814Medicaid
WA126766OtherLABOR & INDUSTRIES
WAG89296Medicare UPIN