SOUTH SOUND INTERNAL MEDICINE PLLC (NPI# 1104987734) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104987734 |
| Entity Type | Organization |
| Organization Name | SOUTH SOUND INTERNAL MEDICINE PLLC |
| Practice Address |
3425 Ensign Rd Ne Suite 220 Olympia WA 98506-5425 |
| Practice Telephone | 3604911112 |
| Practice Fax Number | 3604938160 |
| Mailing Telephone | 3604911112 |
| Mailing Fax Number | 3604938160 |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CATHY HILL (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 3604911112 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171W00000X | Contractor | GAB20096 | WA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | LABOR & INDUSTRIES | 0149442 | 01 |
| WA | COUNTY | 3911 | 01 |
| WA | 7106826 | 05 |
| Street Address |
3425 ENSIGN RD NE SUITE 220 |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98506-5425 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588644413 | Michael Edward Werner | Dentist | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506-5425 | 2006-01-18 |
| 1841619061 | Rodger A. Lawton, Dmd, Ps | Clinic/Center | 3425 Ensign Rd Ne, Suite 210, Olympia, WA 98506-5425 | 2014-04-15 |
| 1902162829 | Gheorghe Emanuel Plesiu | Internal Medicine | 3425 Ensign Rd Ne, Suite 220, Olympia, WA 98506-5063 | 2012-04-04 |
| 1417241282 | Austin Rubel | Dentist | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506-5425 | 2011-06-08 |
| 1730310426 | Peter David Gauger | Dentist | 3425 Ensign Rd Ne, Suite 310, Olympia, WA 98506-5425 | 2009-07-29 |
| 1043476211 | Rodger A Lawton, Dmd, Ps | Dentist | 3425 Ensign Rd Ne, Ste 210, Olympia, WA 98506-5425 | 2008-08-06 |
| 1710161344 | Providence Health & Services Washington | Internal Medicine | 3425 Ensign Rd Ne, Suite 220, Olympia, WA 98506-5063 | 2007-12-18 |
| 1548474075 | Olympia Imaging Center | Clinic/Center | 3425 Ensign Rd Ne, Ste320, Olympia, WA 98506-5425 | 2007-05-10 |
| 1710013263 | Molli A Dutra | Optometrist | 3425 Ensign Rd Ne, Olympia, WA 98506-5425 | 2007-02-26 |
| 1316088602 | Leslie L Gracey | Dentist | 3425 Ensign Rd Ne, Ste 210, Olympia, WA 98506-5425 | 2007-02-09 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477185460 | Chloe Harper | Technician, Other | 3443 Lilly Rd Se, Ste B, Olympia, WA 98506 | 2020-02-07 |
| 1912543539 | Jessica Marie Radakovich | Licensed Practical Nurse | 3426 Mary Elder Rd, Olympia, WA 98506 | 2019-11-19 |
| 1669014973 | Arlene Josephine Adams | Registered Nurse | 413 Lily Rd Ne, Olympia, WA 98506 | 2019-10-09 |
| 1861999120 | Debra Delores Barker | Licensed Practical Nurse | 3710 South Bay Rd Ne, Olympia, WA 98506 | 2018-04-12 |
| 1801304431 | Michelle Warner | Nurse Practitioner | 205 Lilly Rd Ne Ste A1, Olympia, WA 98506 | 2018-01-17 |
| 1396258364 | Institute for Family Development | Community/Behavioral Health | 204 Quince St. Ne, Suite 200, Olympia, WA 98506 | 2017-11-13 |
| 1083137715 | Cameron Kunkel | Specialist/Technologist | 2512 20th Ave Ne, Olympia, WA 98506 | 2017-07-25 |
| 1184144768 | Trevor Shane Kwan | Family Medicine | 525 Lilly Road Ne, Olympia, WA 98506 | 2017-06-23 |
| 1073043212 | Michael H Harburg | Behavior Technician | 3857 Martin Way Ne, Olympia, WA 98506 | 2017-06-19 |
| 1780114371 | Priscilla Kangyang Jadu | Counselor | 3857 Martin Way E., Olympia, WA 98506 | 2017-06-15 |
| Find all providers in zip 98506 | ||||
| Taxonomy Code | 171W00000X |
| Grouping | Other Service Providers |
| Classification | Contractor |
| A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |
| Notes: Source: Websters New World Dictionary of the American Language, Second College Edition, William Collins + World Publishing Co., Inc., New York: 1974, p. 308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760017495 | Estefani Perete Gomez | Contractor | 606 Lilly Rd Ne Apt 324, Olympia, WA 98506-5169 | 2020-03-03 |
| 1912309311 | Ruth Mary Ryser | Contractor | 2920 Quince St Se, Olympia, WA 98501-3583 | 2014-09-17 |
| 1093121444 | Carolyn M Green | Contractor | 1247 Fitz Hugh Dr Se, Olympia, WA 98513-7736 | 2014-07-07 |
| 1568899524 | Nicolaj Peter Keckes-palmer | Contractor | 1144 Milbanke Dr Se, Olympia, WA 98513-7723 | 2013-10-03 |
| 1477987444 | Mercedes M Carbonel | Contractor | 3212 Libby Rd Ne, Olympia, WA 98506-2985 | 2013-08-27 |
| 1891131983 | Michael Helm Jr. | Contractor | 7914 Martin Way E Ste 8, Olympia, WA 98516-5728 | 2013-05-15 |
| 1053693093 | Amanda Mae Crossen | Contractor | 6811 Hawks Prairie Rd Ne, Olympia, WA 98516-6206 | 2011-09-15 |
| 1699898015 | Tina L. Bartlett | Contractor | 507 Devoe St Se, Olympia, WA 98501-2016 | 2007-04-09 |
| 1215050620 | James L. Bartlett | Contractor | 1804 Black Lake Blvd Sw, Olympia, WA 98512 | 2007-04-09 |
| 1326250218 | Marles Blackbird | Contractor | 1001 Eastside St Se, Suite C, Olympia, WA 98501-1608 | 2007-05-04 |
| Find all providers in OLYMPIA | ||||
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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.