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Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Parent organization
WESTERN WASHINGTOM MEDICAL GROUP
Other names
Western Wa Medical Group, Dept of Primary Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WASHINGTOM MEDICAL GROUP
Authorized official
AMELIA EDENS (DIRECTOR OF PATIENT FINANCIAL SVCS)
(425) 740-4142
Entity
Organization
Contact information
Practice address
4225 HOYT AVE STE D, EVERETT, WA 98203-2351
(425) 317-8025
(425) 317-9516
Mailing address
1728 W MARINE VIEW DR STE 110, EVERETT, WA 98201-2094
(425) 317-8025
(425) 317-9516
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
601474013
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0176782
LABOR & INDUSTRY
WA
05
—
7108012
—
WA
01
—
CB3566
RAILROAD MEDICARE
WA
Enumeration date
04/23/2007
Last updated
08/08/2023
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