| Michael G. Blackburn, M.d. , Inc. P.s. | |
|
201 15th Ave Sw Ste C Puyallup WA 98371-7495 | |
| (253) 841-4243 | |
| (253) 864-9452 |
| Full Name | Michael G. Blackburn, M.d. , Inc. P.s. |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 201 15th Ave Sw Ste C, Puyallup, Washington |
| Authorized Official Name and Position | Michael G. Blackburn (OWNER) |
| Authorized Official Contact | 2538414243 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael G. Blackburn, M.d. , Inc. P.s. 201 15th Ave Sw Ste C Puyallup WA 98371-7495 Ph: (253) 841-4243 | Michael G. Blackburn, M.d. , Inc. P.s. 201 15th Ave Sw Ste C Puyallup WA 98371-7495 Ph: (253) 841-4243 |
| NPI Number | 1285801480 |
|---|---|
| Provider Enumeration Date | 05/15/2008 |
| Last Update Date | 07/23/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285801480 | NPI | - | NPPES |
| 1008895 | Medicaid | WA | |
| BL4674 | Other | WA | REGENCE |
| 110008458 | Other | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD00019306 (Washington) | Primary |
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