Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
SOUTH SOUND FAMILY & SPORTS
Active
Organization
SOUTH SOUND FAMILY & SPORTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNY A BLAKE (OPS MANAGER)
(360) 709-9500
Entity
Organization
Contact information
Practice address
2960-A LIMITED LANE NW, OLYMPIA, WA 98502-4541
(360) 709-9500
(360) 754-4517
Mailing address
2960 LIMITED LN NW STE A, OLYMPIA, WA 98502-4541
(360) 709-9500
(360) 754-4517
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
602369889
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50D1031645
CLIA
—
01
—
7122450
DSHS
—
01
—
O186019
L & I
—
Enumeration date
10/25/2006
Last updated
07/10/2012
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign upProduct
Developers