CONCORDIA STAR MEDICAL LLC (NPI# 1508134792) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508134792 |
| Entity Type | Organization |
| Organization Name | CONCORDIA STAR MEDICAL LLC |
| Practice Address |
118 7th Ave Sw Suite A Puyallup WA 98371-6803 |
| Practice Telephone | 2535790067 |
| Practice Fax Number | 2535790068 |
| Mailing Telephone | 2535790067 |
| Mailing Fax Number | 2535790068 |
| Enumeration Date | 2011-12-02 |
| Last Update Date | 2015-05-15 |
| Authorized Official Name | DR. LADIE CHRISTINE ARANA-DOMONDON (OWNER - CEO) |
| Authorized Official Telephone | 2532099009 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
MD00034362 | WA | Ambulatory Health Care Facilities |
| N | 261QU0200X |
Clinic/Center Specialization: Urgent Care |
MD00034362 | WA | Ambulatory Health Care Facilities |
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
MD00034362 | WA | Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790163491 | Concordia Star Medical LLC | Clinic/Center | 118 7th Ave Sw, Suite A, Puyallup, WA 98371-6803 | 2015-05-13 |
| Street Address |
118 7TH AVE SW SUITE A |
| City | PUYALLUP |
| State | WA |
| Zip Code | 98371-6803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306819412 | Ladie C Arana-domondon | Internal Medicine | 118 7th Ave Sw, Suite A, Puyallup, WA 98371-6803 | 2006-02-09 |
| 1801368139 | Kaelin Vince Cruz | Nurse Practitioner | 118 7th Ave Sw, Puyallup, WA 98371-6803 | 2018-12-27 |
| 1790163491 | Concordia Star Medical LLC | Clinic/Center | 118 7th Ave Sw, Suite A, Puyallup, WA 98371-6803 | 2015-05-13 |
| 1023454345 | Jennifer D Anderson | Nurse Practitioner | 118 7th Ave Sw, Puyallup, WA 98371-6803 | 2013-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588141550 | Karen Lynn Sorensen | Massage Therapist | 922 Valley Ave Nw Suite 101, Puyallup, WA 98371 | 2018-07-23 |
| 1487140257 | Bradley Dupea | Specialist/Technologist | 5702 44th St Se, Puyallup, WA 98371 | 2018-07-05 |
| 1740778695 | Pedraum Heydari | Dentist | 109 N Meridian Suite A, Puyallup, WA 98371 | 2018-04-26 |
| 1487030359 | Jennifer Block | Dental Hygienist | 601 4th Ave Sw, Puyallup, WA 98371 | 2015-08-03 |
| 1023423431 | On Your Own Inc. | Registered Nurse | 1602 Peach Park Ln Nw, Puyallup, WA 98371 | 2014-06-24 |
| 1841614997 | Enrique Somera | Registered Nurse | 1107 29th St Nw, Puyallup, WA 98371 | 2014-02-10 |
| 1033540893 | Ching Ju Chuang | Dentist | 1002 N. Meridian, Suite 104a, Puyallup, WA 98371 | 2013-12-04 |
| 1104161876 | Denise L. Vanaman | Registered Nurse | 214 W. Main, Puyallup, WA 98371 | 2012-12-06 |
| 1336491018 | Tacoma School District | Physical Therapy Assistant | 1721 8th Ave. S.w., Puyallup, WA 98371 | 2012-10-05 |
| 1275882052 | Robert Francis Saxton | Health Educator | 1121 W. Stewart, Puyallup, WA 98371 | 2012-09-07 |
| Find all providers in zip 98371 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881237584 | Puget Sound Natural Medicine, LLC | Clinic/Center | 1420 S Meridian Ste A, Puyallup, WA 98371-6914 | 2019-10-25 |
| 1790163491 | Concordia Star Medical LLC | Clinic/Center | 118 7th Ave Sw, Suite A, Puyallup, WA 98371-6803 | 2015-05-13 |
| 1285801480 | Michael G. Blackburn, M.d., Inc. P.s. | Clinic/Center | 201 15th Ave Sw Ste C, Puyallup, WA 98371-7495 | 2008-05-15 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.