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Contact Information

MATT CHILDS
1315 11TH CT SW
NORTH BEND, WA98045-7989
 Phone: 812-251-6639
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Supports Brokerage

251X00000X
Indicates primary specialty

NPI Profile & details for

NPI Number 1134717747
Entity Organization
Organization subpart 1 Not specified
Enumeration date 01/08/2021
Last updated 01/08/2021 - About 5 years ago
Identifiers
WA License # 1031895
Other 19306485 NATIONAL PRODUCER NUMBER
WA Other 1031895 INSURANCE LICENSE NUMBER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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