# WESTERN WASHINGTON MEDICAL GROUP INC PS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WWMG Dept of Neurology Hospitalist, WWMG Dept of Neurology
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568916682
- **Authorized official:** ELIZABETH BAE (CONTRACT ANALYST/CREDENTIALING COOR)
- **Authorized official phone:** (425) 259-4041

## Contact information

- **Practice address:** 12728 19TH AVE SE, SUITE 300, EVERETT, WA 98208-6526
- **Practice address phone:** (425) 259-4041
- **Mailing address:** 1728 W MARINE VIEW DR, SUITE 110, EVERETT, WA 98201-2094
- **Mailing address phone:** (425) 259-4041

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084A2900X | Neurocritical Care Physician | — | NULL | Yes |
| 2084A2900X | Neurocritical Care Physician | — | — | Yes |
| 2084N0400X | Neurology Physician | — | NULL | — |
| 2084N0400X | Neurology Physician | — | — | — |

## Other

- **Enumeration date:** 08/05/2016
- **Last updated:** 06/19/2024