Organization
PACIFIC PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS JAMES THEMELIS M.D. (OWNER)
(253) 536-3336
Entity
Organization
Contact information
Practice address
11601 PACIFIC AVE S, TACOMA, WA 98444-5425
(253) 536-3336
(253) 536-3242
Mailing address
11601 PACIFIC AVE S, TACOMA, WA 98444-5425
(253) 536-3336
(253) 536-3242
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00025303
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018430
—
WA
01
—
TH0534
REGENCE BLUESHIELD
WA
Enumeration date
06/19/2008
Last updated
06/24/2010
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