Basic Information
| Provider Information | |||||||||
| NPI: | 1558356055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELLINGER | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX N | ||||||||
| Address2: | 176 1ST AVE N | ||||||||
| City: | ILWACO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986240319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606423747 | ||||||||
| FaxNumber: | 3606423361 | ||||||||
| Practice Location | |||||||||
| Address1: | 176 1ST AVE N | ||||||||
| Address2: | |||||||||
| City: | ILWACO | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986240319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606423747 | ||||||||
| FaxNumber: | 3606423361 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2005 | ||||||||
| LastUpdateDate: | 05/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA10003595 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1012BE | 01 | WA | BCBS | OTHER | 102563 | 01 | WA | L & I | OTHER |