Provider Demographics
NPI:1801827068
Name:SOUTH HILL GENERAL MEDICAL CLINIC
Entity Type:Organization
Organization Name:SOUTH HILL GENERAL MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MAN KUEN
Authorized Official - Last Name:TSOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-848-1535
Mailing Address - Street 1:10209 136TH ST E
Mailing Address - Street 2:SOUTH HILL GENERAL MEDICAL CLINIC
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374
Mailing Address - Country:US
Mailing Address - Phone:253-848-1535
Mailing Address - Fax:253-848-6537
Practice Address - Street 1:10209 136TH ST E
Practice Address - Street 2:SOUTH HILL GENERAL MEDICAL CLINIC
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374
Practice Address - Country:US
Practice Address - Phone:253-848-1535
Practice Address - Fax:253-848-6537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7252901Medicaid
WA7252901Medicaid