Kenneth Murray Edstrom, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

MD00026074 Issued in WA

Practice address

1701 3Rd St SE
Suite 200
Puyallup, WA 98372-4511

Phone

(253) 840-4444

Fax

(253) 840-5239

NPI assigned

Sep 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GU

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• General Conference Corp of Sda

  dba Guam Seventh-Day Adventist Clinic

  • Clinic/Center
  • Tamuning, GU
  • NPI 1275586877
  Medicare reassignment NPD

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339718400000",
    "number": "1649373663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 3RD ST SE",
            "address_2": "SUITE 200",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983724511",
            "telephone_number": "253-840-4444",
            "fax_number": "253-840-5239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 3RD ST SE",
            "address_2": "SUITE 200",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983724511",
            "telephone_number": "253-840-4444",
            "fax_number": "253-840-5239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDSTROM",
        "first_name": "KENNETH",
        "middle_name": "MURRAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2012-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WA",
            "license": "MD00026074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7085020",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney Edgerton, EAMP
• Carolyn A Edgeworth, R.PH.
• Maryan Edin, LMHC
• Charles V. Edmond Jr., MD
• Melissa Dawn Edmundson, LMP
• Danielle Edwards
• Leiali'I Ruth Edwards, OTD
• Meagan Edwards
• Amy Florence Egbert
• Stephen M. Egge, M.D.

• Obstetrics & Gynecology Physician in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Obstetrics & Gynecology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.