NPIMap

Organization Active NPI

Puyallup Tribal Health Authority

  • Primary Care Clinic/Center
  • Tacoma, WA
National Provider Identifier
1063455665
Registry record updated Jul 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PUYALLUP TRIBAL HEALTH AUTHORITY
Practice address
2209 E 32ND St
Tacoma, WA 98404
Phone
(253) 593-0232
Fax
(253) 382-2091
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2018

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

Authorized official

Name
Ms. Chris Henry
Title
Executive Director
Phone
(253) 593-0232

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X WA
Health Service Clinic/Center 261QH0100X
Podiatric Clinic/Center 261QP1100X
Physical Therapy Clinic/Center 261QP2000X
Primary Care Clinic/Center 261QP2300X Primary
Radiology Clinic/Center 261QR0200X
Clinical Medical Laboratory 291U00000X

Addresses

Primary practice location

2209 E 32ND St
Tacoma, WA 98404

Mailing address

2209 E 32ND St
P.O. Box 8009
Tacoma, WA 98404-4922
Phone (253) 593-0232

Other identifiers 7

IdentifierTypeStateIssuer
PO1874OtherWAREGENCE CLINIC ID
366486001OtherWAGROUP HEALTH OPTIONS-CLIN
7090954MedicaidWA
0042440OtherWALABOR & INDUSTRIES CLINIC
7013220MedicaidWA
5035233MedicaidWA
366486001OtherWAGROUP HEALTH OPTIONS-CD

Other names 2

  • PUYALLUP TRIBAL HEALTH AUTHORITY Doing business as
  • TAKOPID HEALTH CENTER Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040309001482 WA Part B Supplier - Clinic/Group Practice 9436047537 Receives reassigned benefits from 57 practitioners
1 other NPI on this enrollment
Practice locations: Tacoma, WA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

5625 52nd St E
Puyallup, WA 98371

Practitioners & affiliated clinicians

Practitioners 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531440000000",
    "number": "1063455665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 E 32ND ST",
            "address_2": "P.O. BOX 8009",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984044922",
            "telephone_number": "253-593-0232",
            "fax_number": "253-382-2091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 E 32ND ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98404",
            "telephone_number": "253-593-0232",
            "fax_number": "253-382-2091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP TRIBAL HEALTH AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2018-07-13",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "253-593-0232",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "WA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE CLINIC ID",
            "identifier": "PO1874",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH OPTIONS-CLIN",
            "identifier": "366486001",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7090954",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES CLINIC",
            "identifier": "0042440",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7013220",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5035233",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH OPTIONS-CD",
            "identifier": "366486001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PUYALLUP TRIBAL HEALTH AUTHORITY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TAKOPID HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TAKOPID HEALTH CENTER",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jul 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.