Provider Demographics
NPI:1316175094
Name:ENTPSA PUYALLUP ASC
Entity type:Organization
Organization Name:ENTPSA PUYALLUP ASC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PUIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-833-6241
Mailing Address - Street 1:310 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4342
Mailing Address - Country:US
Mailing Address - Phone:253-833-6241
Mailing Address - Fax:253-833-4113
Practice Address - Street 1:1609 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7517
Practice Address - Country:US
Practice Address - Phone:253-833-6241
Practice Address - Fax:253-833-4113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EAR, NOSE, THROAT & PLASTIC SURGERY ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-01
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7133671Medicaid
WA3535ENOtherREGENCE