Healthcare Provider Details

I. General information

NPI: 1720901739
Provider Name (Legal Business Name): LTC-ACO F&M PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6824 19TH ST W # 504
UNIVERSITY PLACE WA
98466-5528
US

IV. Provider business mailing address

6824 19TH ST W # 504
UNIVERSITY PLACE WA
98466-5528
US

V. Phone/Fax

Practice location:
  • Phone: 253-777-1423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. FLOYD DEKERAMAYI
Title or Position: COO
Credential: MD
Phone: 253-314-6904