Healthcare Provider Details

I. General information

NPI: 1063455665
Provider Name (Legal Business Name): PUYALLUP TRIBAL HEALTH AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 E 32ND ST
TACOMA WA
98404
US

IV. Provider business mailing address

2209 E 32ND ST P.O. BOX 8009
TACOMA WA
98404-4922
US

V. Phone/Fax

Practice location:
  • Phone: 253-593-0232
  • Fax: 253-382-2091
Mailing address:
  • Phone: 253-593-0232
  • Fax: 253-382-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRIS HENRY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 253-593-0232