Provider Demographics
NPI:1730208026
Name:NORTH KITSAP PEDIATRICS P.S.
Entity type:Organization
Organization Name:NORTH KITSAP PEDIATRICS P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNIE
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-779-7337
Mailing Address - Street 1:20730 BOND RD NE
Mailing Address - Street 2:#208
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9000
Mailing Address - Country:US
Mailing Address - Phone:360-779-7337
Mailing Address - Fax:360-779-7054
Practice Address - Street 1:20730 BOND RD NE
Practice Address - Street 2:#208
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9000
Practice Address - Country:US
Practice Address - Phone:360-779-7337
Practice Address - Fax:360-779-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1072347Medicaid
WAE32780Medicare UPIN