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General NPI Number Information
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NPI Number | 1780113530
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Entity Type | Organization
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Legal Business Name | COSMAS PRIMARY CARE, P.S.
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Dates
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Enumeration Date | 06/06/2017
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Last Update Date | 06/16/2017
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Provider Practice Location Address
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Address Line | 2115 S 56TH ST STE 103
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City | TACOMA
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State | WA
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Zip | 98409-6900
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Country | US
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Telephone | 253-471-3193
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 64093
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City | UNIVERSITY PLACE
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State | WA
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Zip | 98464-0093
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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 | PRESIDENT
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Name | DR. ROXANNE JUI HO
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Credential | MD
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Telephone | 817-891-3123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 00048903
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License Number State | WA
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