Michael G. Blackburn, M.D. , Inc. P.S.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

MD00019306 Issued in WA

Legal business name

MICHAEL G. BLACKBURN, M.D. , INC. P.S.

Practice address

201 15TH Ave SW Ste C
Puyallup, WA 98371-7495

Phone

(253) 841-4243

Fax

(253) 864-9452

NPI assigned

May 15, 2008

Organization subpart

No

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

Authorized official

Name

Michael G. Blackburn, M.D.

Title

Owner

Phone

(253) 841-4243

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1210809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563840000000",
    "number": "1285801480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 15TH AVE SW STE C",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717495",
            "telephone_number": "253-841-4243",
            "fax_number": "253-864-9452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 15TH AVE SW STE C",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983717495",
            "telephone_number": "253-841-4243",
            "fax_number": "253-864-9452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL G. BLACKBURN, M.D. , INC. P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-15",
        "last_updated": "2019-07-23",
        "status": "A",
        "authorized_official_last_name": "BLACKBURN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-841-4243",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "MD00019306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1008895",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "BL4674",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110008458",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mercades Amanda Meuli, DO
• Alanna Meyer
• Anne Marie Meyer, RN
• Oscar Manual Meza-Valle
• Michael Church
• Michael Philip Podrasky
• Julius Michaelson Jr., M.D.
• Terrel J Michel, M.D.
• Jody Michelsen
• Darby Michieli-Welch

• Primary Care Clinic/Center in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Primary Care Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2019; 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.