CONCORDIA STAR MEDICAL LLC NPI 1508134792

NPI Information

NPI: 1508134792
Provider Name: CONCORDIA STAR MEDICAL LLC
Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

CLIA Number: 50D2034891

Address:
118 7TH AVE SW
SUITE A
PUYALLUP, WA
ZIP 98371
Phone: (253) 579-0067
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CONCORDIA STAR MEDICAL LLC is a primary care clinic center in Puyallup, WA. CONCORDIA STAR MEDICAL LLC NPI is 1508134792. The provider is registered as an organization entity type.

The provider's business location address is:

118 7TH AVE SW
SUITE A
PUYALLUP, WA
ZIP 98371-803
Phone: (253) 579-0067
Fax: (253) 579-0068

The provider's authorized official is Ladie Christine Arana-domondon .
The authorized official title is Owner - Ceo and has the following contact phone number (253) 209-9009.

The CLIA number assigned to this NPI record is 50D2034891 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 12/2/2011 and was last updated on 5/15/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QM1300X	Clinic/Center	Multi-Specialty	MD00034362	WASHINGTON	No
2	261QU0200X	Clinic/Center	Urgent Care	MD00034362	WASHINGTON	No
3	261QP2300X	Clinic/Center	Primary Care	MD00034362	WASHINGTON	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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