NPIMap

Organization Active NPI

Puget Sound Specialty Physicians PLLC

  • Foot & Ankle Surgery Podiatrist
  • Bonney Lake, WA
National Provider Identifier
1144401704
Registry record updated Jun 5, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
Legal business name
PUGET SOUND SPECIALTY PHYSICIANS PLLC
Practice address
19820 Hwy 410 East
Bonney Lake, WA 98391
Phone
(253) 848-6656
Fax
(253) 840-6691
NPI assigned
Nov 23, 2007
Organization subpart
Yes
Parent organization
PUGET SOUND SPECIALTY PHYSICIANS PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 5, 2008

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

Authorized official

Name
Tina M Quevedo
Title
Billing Office Supervisor
Phone
(253) 841-2006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0103X WA Primary

Addresses

Primary practice location

19820 Hwy 410 East
Bonney Lake, WA 98391

Mailing address

2728 E Main Ave
Suite a
Puyallup, WA 98372-3198
Phone (253) 841-2006

Other names 1

  • Ankle & Foot Specialist of Bonney Lake Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Puget Sound Spec Phys PLLC4 organizations share this tax ID, including this one
Part of
Puget Sound Spec Phys PLLC

Other organizations with this tax ID 3

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": "1195776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212624000000",
    "number": "1144401704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2728 E MAIN AVE",
            "address_2": "SUITE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723198",
            "telephone_number": "253-841-2006",
            "fax_number": "253-840-6691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19820 HWY 410 EAST",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "98391",
            "telephone_number": "253-848-6656",
            "fax_number": "253-840-6691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUGET SOUND SPECIALTY PHYSICIANS PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PUGET SOUND SPECIALTY PHYSICIANS PLLC",
        "enumeration_date": "2007-11-23",
        "last_updated": "2008-06-05",
        "status": "A",
        "authorized_official_last_name": "QUEVEDO",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BILLING OFFICE SUPERVISOR",
        "authorized_official_telephone_number": "253-841-2006"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ankle & Foot Specialist of Bonney Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bonney Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2008; 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.