NPIMap

Organization Active NPI

Puyallup Clinic Inc

  • Clinic/Center
  • Puyallup, WA
National Provider Identifier
1497874903
Registry record updated Jul 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
261Q00000X Issued in WA
Legal business name
PUYALLUP CLINIC INC
Practice address
800 S Meridian Ste a
Puyallup, WA 98371-6994
Phone
(253) 845-6645
Fax
(253) 770-2295
NPI assigned
Mar 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2019

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

Authorized official

Name
Jerry Fred Duris, MD
Title
President and Ceo
Phone
(253) 845-6645

Specialties & licenses 1

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

Addresses

Primary practice location

800 S Meridian Ste a
Puyallup, WA 98371-6994

Mailing address

800 S Meridian Ste a
Puyallup, WA 98371-6994
Phone (253) 845-6645

Other identifiers 1

IdentifierTypeStateIssuer
7120363MedicaidWA

Other names 1

  • Puyallup Clinic Inc., PS Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564531200000",
    "number": "1497874903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S MERIDIAN STE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983716994",
            "telephone_number": "253-845-6645",
            "fax_number": "253-770-2295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S MERIDIAN STE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983716994",
            "telephone_number": "253-845-6645",
            "fax_number": "253-770-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2019-07-31",
        "status": "A",
        "authorized_official_last_name": "DURIS",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "FRED",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "253-845-6645",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "261Q00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7120363",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Puyallup Clinic Inc., PS",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 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.