MEDICARE: BETTERIDGE & MCNAUGHTON PS INC

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	207QS0010X	Sports Medicine (Family Medicine) Physician	28116	WA
2	208D00000X	General Practice Physician	15856	WA
3	207Q00000X	Family Medicine Physician	28116	WA

General Provider Information

NPI Number	:	1457552770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTERIDGE & MCNAUGHTON PS INC

Provider Business Mailing Address
First Line	:	3733 S THOMPSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98418-5013
Country	:	US
Telephone Number	:	253-472-4473
Fax Number	:	253-474-3056

Provider Business Practice Location Address
First Line	:	3733 S THOMPSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98418-5013
Country	:	US
Telephone Number	:	253-472-4473
Fax Number	:	253-474-3056

Authorized Official
Title or Position	:	MANAGER
Name	:	KELLEIGH PATRON
Credential	:
Telephone Number	:	253-472-4473

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	10/10/2024

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