Provider Demographics
NPI:1497922421
Name:UNIVERSITY PLACE PEDIATRIC CLINIC P S
Entity Type:Organization
Organization Name:UNIVERSITY PLACE PEDIATRIC CLINIC P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-564-1115
Mailing Address - Street 1:1033 REGENTS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6089
Mailing Address - Country:US
Mailing Address - Phone:253-564-1115
Mailing Address - Fax:253-565-4552
Practice Address - Street 1:1033 REGENTS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6089
Practice Address - Country:US
Practice Address - Phone:253-564-1115
Practice Address - Fax:253-565-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty