| |
915 6th Ave Ste 200 Tacoma WA 98405-4682 | |
(253) 403-7299 | |
(253) 403-7298 |
Full Name | |
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Speciality | Psychiatry & Neurology - Neurology |
Location | 915 6th Ave, Tacoma, Washington |
Authorized Official Name and Position | John Robert Huddlestone (MANAGING MEMBER) |
Authorized Official Contact | 2534037299 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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915 6th Ave Ste 200 Tacoma WA 98405-4682 Ph: (253) 403-7299 | 915 6th Ave Ste 200 Tacoma WA 98405-4682 Ph: (253) 403-7299 |
NPI Number | 1568460707 |
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Provider Enumeration Date | 07/12/2005 |
Last Update Date | 07/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568460707 | NPI | - | NPPES |
7809403 | Medicaid | WA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | (Washington) | Primary |
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