Healthcare Provider Details

I. General information

NPI: 1396696522
Provider Name (Legal Business Name): CARBON HEALTH PRIMARY CARE OF WASHINGTON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10221 156TH ST E STE P1-102
PUYALLUP WA
98374-5690
US

IV. Provider business mailing address

PO BOX 210
PORTSMOUTH NH
03802-0210
US

V. Phone/Fax

Practice location:
  • Phone: 253-292-5297
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARLEY PAGE
Title or Position: DIRECTOR OF CONTRACTING
Credential:
Phone: 417-861-9739