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General NPI Number Information
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NPI Number | 1083504633
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Entity Type | Organization
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Legal Business Name | MEDEVALS LLC
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 5707 LACEY BLVD SE STE 106
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City | LACEY
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State | WA
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Zip | 98503-2496
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Country | US
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Telephone | 360-628-8885
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S 336TH ST STE 150
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5946
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Country | US
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Telephone | 253-733-5615
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Fax |
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Authorized Official
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Title or Position | REGIONAL VICE PRESIDENT
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Name | KRISTIN MCCOY
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Credential |
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Telephone | 253-733-5615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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