Basic Information
| Provider Information | |||||||||
| NPI: | 1316181472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THREE TREE INFUSION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16259 SYLVESTER RD SW | ||||||||
| Address2: | SUITE 404 | ||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062433049 | ||||||||
| FaxNumber: | 2062443991 | ||||||||
| Practice Location | |||||||||
| Address1: | 3819 100TH ST SW | ||||||||
| Address2: | SUITE 7-C | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984994470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535887911 | ||||||||
| FaxNumber: | 2539846774 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2009 | ||||||||
| LastUpdateDate: | 04/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | PORTER | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2062444704 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QI0500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy |
ID Information
| ID | Type | State | Issuer | Description | AP30005421 | 01 | WA | LICENSE | OTHER |