MEDICARE: VA PUGET SOUND HEALTH CARE SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital	PA10002879	WA

General Provider Information

NPI Number	:	1083676340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA PUGET SOUND HEALTH CARE SYSTEM

Provider Business Mailing Address
First Line	:	4015 244TH STREET CT E
Second Line	:
City	:	SPANAWAY
State	:	WA
Zip	:	98387-7009
Country	:	US
Telephone Number	:	253-847-6116
Fax Number	:

Provider Business Practice Location Address
First Line	:	VA PUGET SOUND HEALTH CARE SYSTEM, AMERICAN LAKE D
Second Line	:	9600 VETERANS DRIVE SW
City	:	TACOMA
State	:	WA
Zip	:	98493-0001
Country	:	US
Telephone Number	:	253-582-8440
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN ASSISTANT
Name	:	MR. GLENN PERRY EHLIG
Credential	:	PA-C
Telephone Number	:	253-582-8440

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/22/2020

Similar Medicare Providers

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Practice Location Address:

VA PUGET SOUND HEALTH CARE SYSTEM
TACOMA, WA
98493-0001

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1053312876 — MR. GUY A OMURA RPH, MBA
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1689664526 — MARIANNE ABRAMS ARNP
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1750368411 — MS. LINDSEY T PINEDA LICSW
Practice Location Address:

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98493-0001

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1760455927 — MS. RACHEL SUZANNE WIEBE R.D.
Practice Location Address:

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98493-0001

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1902868755 — DR. APRIL A GERLOCK PH.D., ARNP
Practice Location Address:

VA PUGET SOUND HEALTH CARE SYSTEM , AMERICAN LAKE DIVISION
TACOMA, WA
98493-0001

Practice Phone: 253-582-8440
Practice Fax: 253-589-4136

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