Provider Demographics
NPI:1679771190
Name:MAYHEW PLLC
Entity type:Organization
Organization Name:MAYHEW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAYHEW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-866-4445
Mailing Address - Street 1:1607 COOPER POINT RD NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8325
Mailing Address - Country:US
Mailing Address - Phone:360-866-4445
Mailing Address - Fax:360-866-4577
Practice Address - Street 1:1607 COOPER POINT RD NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8325
Practice Address - Country:US
Practice Address - Phone:360-866-4445
Practice Address - Fax:360-866-4577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADP00001622207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1113984Medicaid
WAAB26612Medicare ID - Type Unspecified
WA1113984Medicaid