NPIMap

Organization Active NPI

Avalon Clinic

  • Clinic/Center
  • Lakewood, WA
National Provider Identifier
1265654958
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
MD00015225 Issued in WA
Legal business name
AVALON CLINIC
Practice address
6103 Mount Tacoma Dr SW
Lakewood, WA 98499-2727
Phone
(253) 582-8486
Fax
(253) 582-2644
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

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

Authorized official

Name
Dr. Robert J. Kenevan, M.D.
Title
Medical Director
Phone
(253) 582-8486

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X MD00015225 WA Primary

Addresses

Primary practice location

6103 Mount Tacoma Dr SW
Lakewood, WA 98499-2727

Mailing address

6103 Mount Tacoma Dr SW
Lakewood, WA 98499-2727
Phone (253) 582-8486

National Provider Directory

National Provider Directory
Tax ID family
Avalon Clinic4 organizations share this tax ID, including this one

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": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1265654958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6103 MOUNT TACOMA DR SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992727",
            "telephone_number": "253-582-8486",
            "fax_number": "253-582-2644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6103 MOUNT TACOMA DR SW",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984992727",
            "telephone_number": "253-582-8486",
            "fax_number": "253-582-2644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVALON CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "KENEVAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "253-582-8486",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "MD00015225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2012; 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.