NPIMap

Organization Active NPI

Pierce County Jail Clinic

  • Medical Physician Assistant
  • Tacoma, WA
National Provider Identifier
1013231695
Registry record updated Mar 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA10001047 Issued in WA
Legal business name
PIERCE COUNTY JAIL CLINIC
Practice address
910 Tacoma Ave S
Tacoma, WA 98402-2104
Phone
(253) 798-3442
Fax
(253) 798-4043
NPI assigned
Mar 25, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Miguel Balderrama
Title
Jail Medical Director
Phone
(253) 798-7402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AM0700X PA10001047 WA Primary

Addresses

Primary practice location

910 Tacoma Ave S
Tacoma, WA 98402-2104

Mailing address

910 Tacoma Ave S
Tacoma, WA 98402-2104
Phone (253) 798-3442

Other identifiers 2

IdentifierTypeStateIssuer
8476145MedicaidWA
PA10001047OtherWAPA LICENSE

National Provider Directory

National Provider Directory
Tax ID family
Pierce County Juvenile Court7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1269475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269475200000",
    "number": "1013231695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 TACOMA AVE S",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984022104",
            "telephone_number": "253-798-3442",
            "fax_number": "253-798-4043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 TACOMA AVE S",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984022104",
            "telephone_number": "253-798-3442",
            "fax_number": "253-798-4043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIERCE COUNTY JAIL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-25",
        "last_updated": "2010-03-25",
        "status": "A",
        "authorized_official_last_name": "BALDERRAMA",
        "authorized_official_first_name": "MIGUEL",
        "authorized_official_title_or_position": "JAIL MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "253-798-7402",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10001047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8476145",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA10001047",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.