Puyallup Valley Pediatric Associates, P.S.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

PUYALLUP VALLEY PEDIATRIC ASSOCIATES, P.S.

Practice address

1322 3Rd St SE
Suite #240
Puyallup, WA 98372-3771

Phone

(253) 848-1572

Fax

(253) 841-3719

NPI assigned

May 16, 2007

Organization subpart

No

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

Authorized official

Name

Timothy B Jolley, M.D.

Title

Owner

Phone

(253) 848-1572

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/15354/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1179273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497962831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 3RD ST SE",
            "address_2": "SUITE #240",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723771",
            "telephone_number": "253-848-1572",
            "fax_number": "253-841-3719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1322 3RD ST SE",
            "address_2": "SUITE #240",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723771",
            "telephone_number": "253-848-1572",
            "fax_number": "253-841-3719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP VALLEY PEDIATRIC ASSOCIATES, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOLLEY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-848-1572",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7142607",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Puyallup Psychotherapeutic Alliance
• Puyallup Radiological Assocs, Inc.
• Puyallup Regenerative Medicine, PLLC
• Puyallup School District
• Puyallup Spine and Injury Center
• Puyallup Valley Physical Therapy, Inc. P. S.
• Puyallup Valley St. Francis House
• Puyallup Valley Women'S Clinic, Inc.,P.S.
• Puyallup Vision Center PS
• Puyallup Wellness Center

• Pediatric Adolescent Medicine Physician in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Pediatric Adolescent Medicine Physician in Washington

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.