Provider Demographics
NPI:1174116123
Name:SOUND FAMILY SENIOR CLINIC PLLC
Entity type:Organization
Organization Name:SOUND FAMILY SENIOR CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-286-3234
Mailing Address - Street 1:2904 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98372-7053
Mailing Address - Country:US
Mailing Address - Phone:253-848-5951
Mailing Address - Fax:
Practice Address - Street 1:3909 10TH ST SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-2189
Practice Address - Country:US
Practice Address - Phone:253-848-5951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH HILL FAMILY MEDICINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty