Healthcare Provider Details

I. General information

NPI: 1215194576
Provider Name (Legal Business Name): PUYALLUP VALLEY WOMEN'S CLINIC, INC.,P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 14TH AVE SE
PUYALLUP WA
98372-4683
US

IV. Provider business mailing address

520 14TH AVE SE
PUYALLUP WA
98372-4683
US

V. Phone/Fax

Practice location:
  • Phone: 253-845-1962
  • Fax: 253-770-8640
Mailing address:
  • Phone: 253-845-1962
  • Fax: 253-770-8640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14802
License Number StateWA

VIII. Authorized Official

Name: DR. BRUCE D. ROMIG
Title or Position: OWNER
Credential: M.D.
Phone: 253-845-1962