Healthcare Provider Details

I. General information

NPI: 1083504633
Provider Name (Legal Business Name): MEDEVALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 LACEY BLVD SE STE 106
LACEY WA
98503-2496
US

IV. Provider business mailing address

505 S 336TH ST STE 150
FEDERAL WAY WA
98003-5946
US

V. Phone/Fax

Practice location:
  • Phone: 360-628-8885
  • Fax:
Mailing address:
  • Phone: 253-733-5615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN MCCOY
Title or Position: REGIONAL VICE PRESIDENT
Credential:
Phone: 253-733-5615