Provider Demographics
NPI:1689273955
Name:SISU HEALTH PC
Entity Type:Organization
Organization Name:SISU HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOY
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:970-331-1507
Mailing Address - Street 1:PO BOX 1401
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-3401
Mailing Address - Country:US
Mailing Address - Phone:253-549-9216
Mailing Address - Fax:
Practice Address - Street 1:1824 BLACK LAKE BLVD SW STE 101
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5714
Practice Address - Country:US
Practice Address - Phone:970-331-1507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center