Provider Demographics
NPI:1801312442
Name:CMHPOD PLLC
Entity type:Organization
Organization Name:CMHPOD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:253-987-9111
Mailing Address - Street 1:16515 MERIDIAN E STE 105B
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6253
Mailing Address - Country:US
Mailing Address - Phone:253-987-9111
Mailing Address - Fax:844-827-2764
Practice Address - Street 1:16515 MERIDIAN E STE 105B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-6253
Practice Address - Country:US
Practice Address - Phone:253-987-9111
Practice Address - Fax:844-827-2764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-15
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP060211118213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty