=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215194576
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PUYALLUP VALLEY WOMEN'S CLINIC, INC.,P.S.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 05/22/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 520 14TH AVE SE
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-4683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-845-1962
-----------------------------------------------------
Fax | 253-770-8640
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 520 14TH AVE SE
-----------------------------------------------------
City | PUYALLUP
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98372-4683
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-845-1962
-----------------------------------------------------
Fax | 253-770-8640
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. BRUCE D. ROMIG
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 253-845-1962
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 14802
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------