Healthcare Provider Details

I. General information

NPI: 1225674963
Provider Name (Legal Business Name): MULTICARE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2019
Last Update Date: 11/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 POINT FOSDICK DR STE 319
GIG HARBOR WA
98335-1731
US

IV. Provider business mailing address

P.O. BOX 5299 MS: 737-3-PCON
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 253-853-3888
  • Fax:
Mailing address:
  • Phone: 253-459-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY WILLIAMS
Title or Position: MANAGER, PROVIDER DATA & ENROLLMENT
Credential:
Phone: 253-459-8009