Healthcare Provider Details

I. General information

NPI: 1578830758
Provider Name (Legal Business Name): SYNERGY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S 336TH ST
FEDERAL WAY WA
98003-6311
US

IV. Provider business mailing address

3616 N STEVENS ST
TACOMA WA
98407-5631
US

V. Phone/Fax

Practice location:
  • Phone: 253-237-0610
  • Fax: 253-237-0606
Mailing address:
  • Phone: 253-651-3553
  • Fax: 253-237-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD00033511
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD00033511
License Number StateWA

VIII. Authorized Official

Name: ANJA CRIDER
Title or Position: OWNER
Credential: MD
Phone: 253-651-3553