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General NPI Number Information
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NPI Number | 1972871838
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Entity Type | Organization
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Legal Business Name | UNITED STATES PUBLIC HEALTH SERVICE
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 1623 E J ST
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City | TACOMA
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State | WA
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Zip | 98421-1602
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Country | US
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Telephone | 253-552-4947
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Fax | 253-779-6005
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Provider Business Mailing Address
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Address Line | 1623 E J ST
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City | TACOMA
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State | WA
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Zip | 98421-1602
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Country | US
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Telephone | 253-552-4947
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Fax | 253-779-6005
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Authorized Official
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Title or Position | HEALTH SERVICE ADMINITRATOR
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Name | JONHNNY BROUSSARD
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Credential |
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Telephone | 253-779-6052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | AP30005661
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License Number State | WA
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