NPIMap

Organization Active NPI

Concordia Star Medical LLC

  • Primary Care Clinic/Center
  • Puyallup, WA
National Provider Identifier
1508134792
Registry record updated May 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
MD00034362 Issued in WA
Legal business name
CONCORDIA STAR MEDICAL LLC
Practice address
118 7TH Ave SW
Suite a
Puyallup, WA 98371-6803
Phone
(253) 579-0067
Fax
(253) 579-0068
NPI assigned
Dec 2, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2015

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

Authorized official

Name
Dr. Ladie Christine Arana-Domondon, M.D.NPI 1306819412
Title
Owner - Ceo
Phone
(253) 209-9009

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X MD00034362 WA
Primary Care Clinic/Center 261QP2300X MD00034362 WA Primary
Urgent Care Clinic/Center 261QU0200X MD00034362 WA

Addresses

Primary practice location

118 7TH Ave SW
Suite a
Puyallup, WA 98371-6803

Mailing address

118 7TH Ave SW
Suite a
Puyallup, WA 98371-6803
Phone (253) 579-0067

National Provider Directory

National Provider Directory

Locations

220 15th Ave SE
Ste B
Puyallup, WA 98372
Phone (253) 579-0067

Practitioners & affiliated clinicians

Practitioners 3

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": "1322784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431648000000",
    "number": "1508134792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 7TH AVE SW",
            "address_2": "SUITE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983716803",
            "telephone_number": "253-579-0067",
            "fax_number": "253-579-0068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 7TH AVE SW",
            "address_2": "SUITE A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983716803",
            "telephone_number": "253-579-0067",
            "fax_number": "253-579-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCORDIA STAR MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-02",
        "last_updated": "2015-05-15",
        "status": "A",
        "authorized_official_last_name": "ARANA-DOMONDON",
        "authorized_official_first_name": "LADIE",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER - CEO",
        "authorized_official_telephone_number": "253-209-9009",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "WA",
            "license": "MD00034362",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WA",
            "license": "MD00034362",
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "WA",
            "license": "MD00034362",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 May 15, 2015; 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.