Prudencio G Tible MD PC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PRUDENCIO G TIBLE MD PC

Practice address

5023 S Barton Place
Seattle, WA 98118

Phone

(206) 725-8043

Fax

(206) 760-1359

NPI assigned

Sep 15, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Prudencio Galvez Tible, MD

Title

President

Phone

(206) 725-8043

Specialties & licenses 1

Addresses

Other names 1

• Ranier Beach Medical Clinic Doing business as

Locations

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1053417675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 18936",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98118",
            "telephone_number": "206-725-8043",
            "fax_number": "206-760-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5023 S BARTON PLACE",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "98118",
            "telephone_number": "206-725-8043",
            "fax_number": "206-760-1359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRUDENCIO G TIBLE MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TIBLE",
        "authorized_official_first_name": "PRUDENCIO",
        "authorized_official_middle_name": "GALVEZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "206-725-8043",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ranier Beach Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristin Ann Province, ARNP
• Jessica Provost, ARNP, DNP
• Matthew Vaughn Edward Provost
• Tracy L Provost, PT
• Amanda Pruden, ATC, AT/L
• John Leon Prueitt Jr., M.D.
• Suartcha Prueksaritanond, M.D.
• Dena R Pruitt, PAC
• Joanna Pruitt
• Leslie Ann Pruitt, DPT

• Clinic/Center in Seattle, WA
• Providers in Seattle, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.