Healthcare Provider Details

I. General information

NPI: 1457408221
Provider Name (Legal Business Name): PACIFIC OTOLARYNGOLOGY PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S UNION AVE B-2010
TACOMA WA
98405-1702
US

IV. Provider business mailing address

1901 S UNION AVE B-2010
TACOMA WA
98405-1702
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-4502
  • Fax: 253-627-4465
Mailing address:
  • Phone: 253-627-4502
  • Fax: 253-627-4465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS JAMES HAMILL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 253-627-4502