County of Pierce

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

RFT-1077 Issued in WA

Legal business name

COUNTY OF PIERCE

Doing business as

Pierce County Residential Treatment Facility

Practice address

3580 Pacific Ave
Tacoma, WA 98418-7915

Phone

(253) 798-4500

Fax

(253) 798-4493

NPI assigned

Feb 19, 2009

Organization subpart

Yes

Parent organization

COUNTY OF PIERCEAs reported in NPPES

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

Authorized official

Name

Mr. David E. Stewart

Title

Director

Phone

(253) 798-4500

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Pierce County Residential Treatment Facility Doing business as

Part of

Pierce County Juvenile Court

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Johann V Bernardo, MD

  • Internal Medicine Physician
  • Tacoma, WA
  • NPI 1326057688
  NPD (past)
• Eugene Thomas Etzkorn, M.D.

  • Infectious Disease Physician
  • Tacoma, WA
  • NPI 1134109242
  NPD (past)
• Munawar P. Mumtaz, M.D.

  • Family Medicine Physician
  • JBLM, WA
  • NPI 1982762316
  NPD (past)

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

{
    "created_epoch": "1235001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235001600000",
    "number": "1043459720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984187915",
            "telephone_number": "253-798-4500",
            "fax_number": "253-798-4493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 PACIFIC AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984187915",
            "telephone_number": "253-798-4500",
            "fax_number": "253-798-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF PIERCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF PIERCE",
        "enumeration_date": "2009-02-19",
        "last_updated": "2009-02-19",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "253-798-4500",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "WA",
            "license": "RFT-1077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6030548",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7142797",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7136344",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7139710",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9657370",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pierce County Residential Treatment Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tianniah Cotten
• Bradley Cotter, M.A.P.
• Daniel J Coughlin, M.D.
• Jessica Coulter, MD
• Montana Flynn Coulter
• County of Pierce
• County of Pierce
• County of Pierce
• County of Pierce
• County of Pierce

• Community/Behavioral Health Agency in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Community/Behavioral Health Agency in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; 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.