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General NPI Number Information
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NPI Number | 1720901739
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Entity Type | Organization
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Legal Business Name | LTC-ACO F&M PLLC
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Dates
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Enumeration Date | 08/04/2026
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Last Update Date | 08/04/2026
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Provider Practice Location Address
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Address Line | 6824 19TH ST W # 504
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-5528
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Country | US
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Telephone | 253-777-1423
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Fax |
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Provider Business Mailing Address
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Address Line | 6824 19TH ST W # 504
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98466-5528
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | COO
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Name | DR. FLOYD DEKERAMAYI
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Credential | MD
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Telephone | 253-314-6904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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