Healthcare Provider Details

I. General information

NPI: 1457552770
Provider Name (Legal Business Name): BETTERIDGE & MCNAUGHTON PS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 S THOMPSON AVE
TACOMA WA
98418-5013
US

IV. Provider business mailing address

3733 S THOMPSON AVE
TACOMA WA
98418-5013
US

V. Phone/Fax

Practice location:
  • Phone: 253-472-4473
  • Fax: 253-474-3056
Mailing address:
  • Phone: 253-472-4473
  • Fax: 253-474-3056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number28116
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15856
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28116
License Number StateWA

VIII. Authorized Official

Name: KELLEIGH PATRON
Title or Position: MANAGER
Credential:
Phone: 253-472-4473