NPIMap

Organization Active NPI

Sand Medical Clinic

  • Primary Care Clinic/Center
  • Bonney Lake, WA
National Provider Identifier
1407687965
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
SAND MEDICAL CLINIC
Practice address
7720 190TH Ave E
Bonney Lake, WA 98391-7010
Phone
(253) 374-5183
NPI assigned
Aug 8, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Authorized official

Name
Samwel Mbua, ARNPNPI 1821607300
Title
Governor
Phone
(206) 356-0906

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

7720 190TH Ave E
Bonney Lake, WA 98391-7010

Mailing address

7720 190TH Ave E
Bonney Lake, WA 98391-7010
Phone (253) 374-5183

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1723075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1407687965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7720 190TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983917010",
            "telephone_number": "253-374-5183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7720 190TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983917010",
            "telephone_number": "253-374-5183"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-08",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "MBUA",
        "authorized_official_first_name": "SAMWEL",
        "authorized_official_title_or_position": "GOVERNOR",
        "authorized_official_telephone_number": "206-356-0906",
        "authorized_official_credential": "ARNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 8, 2024; 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.