NPIMap

Organization Active NPI

Puyallup Tribal Opioid Clinic, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Tacoma, WA
National Provider Identifier
1992582613
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
PUYALLUP TRIBAL OPIOID CLINIC, INC.
Practice address
503 East 26TH St
Tacoma, WA 98421
Phone
(253) 881-7001
NPI assigned
Sep 14, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Robert Louis Kershner
Title
Manager
Phone
(303) 859-2742

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary

Addresses

Primary practice location

503 East 26TH St
Tacoma, WA 98421

Mailing address

6650 Gunpark Dr Ste 100
Boulder, CO 80301-7003

Other names 1

  • Cedar Wellness Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments
Opioid treatment program
Medicare-enrolled since Mar 12, 2025

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240523001533 TX Part B Supplier - Opioid Treatment Program (Otp) 4486096377 Practice locations: Tacoma, WA
O20241029002291 TX Part B Supplier - Clinic/Group Practice 4486096377 Receives reassigned benefits from 25 practitioners
Practice locations: Tacoma, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2296244Cedar Wellness Center503 E. 26TH Street, Tacoma, WA 98421Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Locations

503 E 26th St
Tacoma, WA 98421
Phone (253) 881-7001

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1694649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1992582613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6650 GUNPARK DR STE 100",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803017003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 EAST 26TH ST",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98421",
            "telephone_number": "253-881-7001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUYALLUP TRIBAL OPIOID CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-14",
        "last_updated": "2024-03-07",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "KERSHNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "303-859-2742"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.