NPIMap

Organization Active NPI

Coast Spine and Sports Medicine PLLC

Doing business as Coast Injury Medicine

  • Physical Medicine & Rehabilitation Physician
  • Lacey, WA
National Provider Identifier
1790401016
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
COAST SPINE AND SPORTS MEDICINE PLLC
Doing business as
Coast Injury Medicine
Practice address
8140 Freedom LN NE Ste a
Lacey, WA 98516-4752
Phone
(253) 648-1853
Fax
(425) 800-9756
NPI assigned
Oct 18, 2022
Last updated
Jul 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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

Authorized official

Name
Sandy Clemens
Title
Access Manager
Phone
(536) 481-8532

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X NU Primary

Addresses

Primary practice location

8140 Freedom LN NE Ste a
Lacey, WA 98516-4752

Mailing address

8012 112TH Street CT E Ste 120
Puyallup, WA 98373-7856
Phone (253) 648-1853

Other names 1

  • Coast Injury Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Coast Injury Medicine6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1666051200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720137600000",
    "number": "1790401016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8012 112TH STREET CT E STE 120",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983737856",
            "telephone_number": "253-648-1853",
            "fax_number": "425-800-9756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8140 FREEDOM LN NE STE A",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985164752",
            "telephone_number": "253-648-1853",
            "fax_number": "425-800-9756"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COAST SPINE AND SPORTS MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-18",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A",
        "authorized_official_last_name": "CLEMENS",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "ACCESS MANAGER",
        "authorized_official_telephone_number": "536-481-8532"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Coast Injury Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; 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.