1689749715 NPI number — PEARL PLACE WOMENS CARE

Table of content: (NPI 1689749715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689749715 NPI number — PEARL PLACE WOMENS CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEARL PLACE WOMENS CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689749715
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6002 WESTGATE BLVD
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98406-2570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-761-2244
Provider Business Mailing Address Fax Number:
253-761-1040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6002 WESTGATE BLVD
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98406-2570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-761-2244
Provider Business Practice Location Address Fax Number:
253-761-1040
Provider Enumeration Date:
11/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SANFORD
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
253-761-2244

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5413PE . This is a "REGENCE BLUE SHIELD GROUP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 7116064 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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