PUYALLUP CLINIC INC NPI 1497874903

NPI Information

  • NPI: 1497874903
  • Provider Name: PUYALLUP CLINIC INC
  • Classification: Clinic/Center - 261Q00000X
  • Entity Type: Organization
  • Former Legal Business Name: PUYALLUP CLINIC INC., PS
  • Address: 800 S MERIDIAN STE A
    PUYALLUP, WA
    ZIP 98371
  • Phone: (253) 845-6645

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NPI Details

PUYALLUP CLINIC INC is a clinic center in Puyallup, WA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). PUYALLUP CLINIC INC NPI is 1497874903. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Puyallup Clinic Inc., Ps.

The provider's business location address is:

800 S MERIDIAN STE A
PUYALLUP, WA
ZIP 98371-994
Phone: (253) 845-6645
Fax: (253) 770-2295

The provider's authorized official is Jerry Fred Duris .
The authorized official title is President And Ceo and has the following contact phone number (253) 845-6645.

The enumeration date for this NPI number is 3/28/2007 and was last updated on 7/31/2019.

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
1261Q00000XClinic/Center261Q00000XWASHINGTONYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
17120363MEDICAIDWASHINGTON

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: 11/21/2025

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