Bonney Lake Medical Center

Primary specialty

SpecialistTaxonomy code 174400000X

License

MD00036489 Issued in WA

Legal business name

BONNEY LAKE MEDICAL CENTER

Practice address

20631 Hwy 410 E.
Ste 303
Bonney Lake, WA 98390-6390

Phone

(253) 891-2160

Fax

(253) 891-2171

NPI assigned

Mar 7, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Mythili R Arigala, M.D.

Title

Owner

Phone

(253) 891-2160

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1204848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1700056587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20631 HWY 410 E.",
            "address_2": "STE 303",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983906390",
            "telephone_number": "253-891-2160",
            "fax_number": "253-891-2171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20631 HWY 410 E.",
            "address_2": "STE 303",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983906390",
            "telephone_number": "253-891-2160",
            "fax_number": "253-891-2171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNEY LAKE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-07",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "ARIGALA",
        "authorized_official_first_name": "MYTHILI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-891-2160",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": "MD00036489",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1117456",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; 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.