Puyallup Children's Clinic, PLLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

PUYALLUP CHILDREN'S CLINIC, PLLC

Practice address

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

Phone

(253) 848-1572

Fax

(253) 841-3719

NPI assigned

May 16, 2007

Last updated

Aug 22, 2020By the provider in NPPES

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.NPI 1407907504

Title

Owner

Phone

(253) 848-1572

Specialties & licenses 1

Addresses

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.

• Timothy B Jolley, M.D.

  • General Practice Physician
  • Puyallup, WA
  • NPI 1407907504
  Authorized official Same address or phone

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": "1841407285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1322 3RD ST SE",
            "address_2": "STE #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": "STE #240",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723771",
            "telephone_number": "253-848-1572",
            "fax_number": "253-841-3719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP CHILDREN'S CLINIC, PLLC",
        "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": [],
    "endpoints": [],
    "other_names": []
}

• John D. Putnam, M.D.
• Eric Geoffrey Puttler, M.D.
• Allen Lee Putz
• Puyallup Ambulatory Surgery Center, LLC
• Puyallup Care Center, Inc (Regency at Puyallup Rehabilitation Center)
• Puyallup Clinic Inc
• Puyallup Dental, LLC
• Puyallup Dermatology Clinic Inc P.S.
• Puyallup Endocrine & Nuclear Medicine Clinics
• Puyallup Imaging Consultants LLC

• 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.