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3713 Pacific Ave Tacoma WA 98418-7839 | |
(253) 433-7993 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 3713 Pacific Ave, Tacoma, Washington |
Authorized Official Name and Position | Claudia Johnson (OWNER/ADMINISTRATOR) |
Authorized Official Contact | 2533013865 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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3713 Pacific Ave Tacoma WA 98418-7839 Ph: (253) 433-7993 | 3713 Pacific Ave Tacoma WA 98418-7839 Ph: (253) 433-7993 |
NPI Number | 1396510970 |
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Provider Enumeration Date | 11/23/2023 |
Last Update Date | 07/30/2024 |
Certification Date | 07/30/2024 |
Medicare PECOS PAC ID | 0042652257 |
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Medicare Enrollment ID | O20240910004906 |
Identifier | Type | State | Issuer |
---|---|---|---|
1396510970 | NPI | - | NPPES |
BHA.FS.61514742 | Other | WA | WA DOH |
2284497 | Medicaid | WA |
Provider Name | Abebe F Belete |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1871131151 PECOS PAC ID: 1052747862 Enrollment ID: I20200213002248 |
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