# NORTHWEST MOBILE ANESTHESIA GROUP, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225289838
- **Authorized official:** BONNIE SONG M.D. (OWNER)
- **Authorized official phone:** (360) 727-8044

## Contact information

- **Practice address:** 17307 NE 32ND AVE, RIDGEFIELD, WA 98642-7972
- **Practice address phone:** (360) 727-8044
- **Practice address fax:** (360) 727-7924
- **Mailing address:** 17307 NE 32ND AVE, RIDGEFIELD, WA 98642-7972
- **Mailing address phone:** (360) 727-8044
- **Mailing address fax:** (360) 727-7924

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | MD00046439 | WA | Yes |
| 261QA1903X | Ambulatory Surgical Clinic/Center | MD28387 | OR | — |

## Other

- **Enumeration date:** 10/02/2008
- **Last updated:** 10/02/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1124577 | — | WA |