Healthcare Provider Details

I. General information

NPI: 1801312442
Provider Name (Legal Business Name): CMHPOD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16515 MERIDIAN E STE 105B
PUYALLUP WA
98375-6253
US

IV. Provider business mailing address

16515 MERIDIAN E STE 105B
PUYALLUP WA
98375-6253
US

V. Phone/Fax

Practice location:
  • Phone: 253-987-9111
  • Fax: 844-827-2764
Mailing address:
  • Phone: 253-987-9111
  • Fax: 844-827-2764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP060211118
License Number StateWA

VIII. Authorized Official

Name: DR. CODY MARK HOOVER
Title or Position: OWNER
Credential: DPM
Phone: 253-987-9111