Organization Active NPI

Pediatrics Northwest PS

  • Pediatrics Physician
  • Tacoma, WA
National Provider Identifier
1497841571
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
PEDIATRICS NORTHWEST PS
Practice address
316 Martin Luther King Jr Way
#212
Tacoma, WA 98405
Phone
(253) 383-5777
Fax
(253) 627-0855
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Lawrence A Larson, DO
Title
President
Phone
(253) 383-5777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

316 Martin Luther King Jr Way
#212
Tacoma, WA 98405

Mailing address

316 Martin Luther King Jr Way
#212
Tacoma, WA 98405
Phone (253) 383-5777

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2172706Pediatrics Northwest PS - Mary Bridge Children'S316 Martin Luther King Jr Way Ste 212, Tacoma, WA 98405Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

316 S K St
Ste 212
Tacoma, WA 98405
Phone (253) 383-5777

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": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497841571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 MARTIN LUTHER KING JR WAY",
            "address_2": "#212",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98405",
            "telephone_number": "253-383-5777",
            "fax_number": "253-383-5320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 MARTIN LUTHER KING JR WAY",
            "address_2": "#212",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98405",
            "telephone_number": "253-383-5777",
            "fax_number": "253-627-0855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRICS NORTHWEST PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-383-5777",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.