Provider Demographics
NPI:1538308143
Name:CHRIS NICHOLS MD PS
Entity type:Organization
Organization Name:CHRIS NICHOLS MD PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-973-5916
Mailing Address - Street 1:6002 WESTGATE BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2570
Mailing Address - Country:US
Mailing Address - Phone:253-759-4522
Mailing Address - Fax:253-759-4699
Practice Address - Street 1:6002 WESTGATE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2571
Practice Address - Country:US
Practice Address - Phone:253-759-4522
Practice Address - Fax:253-759-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049126261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty