Provider Demographics
NPI:1205112281
Name:ABRIA BREAST CENTER PLLC
Entity type:Organization
Organization Name:ABRIA BREAST CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-426-3148
Mailing Address - Street 1:1625 E 72ND ST
Mailing Address - Street 2:SUITE 700-447
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-5455
Mailing Address - Country:US
Mailing Address - Phone:253-426-3107
Mailing Address - Fax:253-840-6810
Practice Address - Street 1:10317 122ND ST E
Practice Address - Street 2:SUITE A
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2632
Practice Address - Country:US
Practice Address - Phone:253-426-3107
Practice Address - Fax:253-840-6810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-23
Last Update Date:2011-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA603023906208100000X, 2081P2900X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty