Healthcare Provider Details

I. General information

NPI: 1619057650
Provider Name (Legal Business Name): SOUTH PUGET SOUND HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW
TACOMA WA
98493-0003
US

IV. Provider business mailing address

9600 VETERANS DR SW
TACOMA WA
98493-0003
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-1285
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License NumberRNOO143836
License Number StateWA

VIII. Authorized Official

Name: DENISE M BERISH
Title or Position: RN
Credential:
Phone: 253-912-4771