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10217 125th Street Ct E Ste 300 Puyallup WA 98374-2761 | |
| (253) 280-9836 | |
| (253) 280-9853 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 10217 125th Street Ct E Ste 300, Puyallup, Washington |
| Authorized Official Name and Position | Mary Bartolo (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 2067635277 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 34703 Seattle WA 98124-1703 Ph: () - | 10217 125th Street Ct E Ste 300 Puyallup WA 98374-2761 Ph: (253) 280-9836 |
| NPI Number | 1992362008 |
|---|---|
| Provider Enumeration Date | 05/23/2019 |
| Last Update Date | 01/31/2025 |
| Certification Date | 01/31/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992362008 | NPI | - | NPPES |
| 2142116 | Medicaid | WA |
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