Provider Demographics
NPI:1699802728
Name:WOODCREEK PEDIATRICS, PLLC
Entity type:Organization
Organization Name:WOODCREEK PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-446-3226
Mailing Address - Street 1:1706 S MERIDIAN
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7516
Mailing Address - Country:US
Mailing Address - Phone:253-848-8797
Mailing Address - Fax:253-845-0100
Practice Address - Street 1:1706 S MERIDIAN
Practice Address - Street 2:SUITE 120
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7516
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:253-845-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty