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General NPI Number Information
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NPI Number | 1063455665
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Entity Type | Organization
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Legal Business Name | PUYALLUP TRIBAL HEALTH AUTHORITY
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 2209 E 32ND ST
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City | TACOMA
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State | WA
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Zip | 98404
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Country | US
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Telephone | 253-593-0232
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Fax | 253-382-2091
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Provider Business Mailing Address
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Address Line | 2209 E 32ND ST P.O. BOX 8009
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City | TACOMA
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State | WA
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Zip | 98404-4922
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Country | US
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Telephone | 253-593-0232
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Fax | 253-382-2091
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CHRIS HENRY
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Credential |
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Telephone | 253-593-0232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State | WA
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Taxonomy #7
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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