Amnesia LLC

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

AMNESIA LLC

Practice address

4717 S 19TH St
Tacoma, WA 98405-1167

Phone

(253) 761-0861

NPI assigned

Jun 14, 2007

Organization subpart

No

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

Authorized official

Name

Brock M Smith, CRNA, ARNP

Title

Owner

Phone

(360) 753-3516

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922202688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3819 100TH ST SW",
            "address_2": "SUITE 7C",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984994470",
            "telephone_number": "253-588-7911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4717 S 19TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984051167",
            "telephone_number": "253-761-0861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMNESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "BROCK",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-753-3516",
        "authorized_official_credential": "CRNA, ARNP"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9652017",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• America's Best Contacts & Eyeglasses
• American Current Care of Washington, P.S. (Concentra Urgent Care)
• Diane Elizabeth Ames, ARNP
• Juliana Desiree Darlene Amesquita
• Jessica Amigo, MSN, PMHNP-BC
• Kwabena Oduro-Nelson Amoah-Forson
• Catrinna Amorelli, OTR/L, CHT
• Paul J Amoroso, MD, MPH
• Chauntel Amos
• Cassandra Bunighruk Amouak-Hale, DPT

• Anesthesiology Physician in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Anesthesiology 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.