# NORTHWEST CARDIOVASCULAR

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

## Provider details

- **NPI number:** 1700902368
- **Authorized official:** MRS. GLENDA LEE MEDEEN (BUSINESS MANAGER)
- **Authorized official phone:** (253) 572-8777

## Contact information

- **Practice address:** 1812 S J ST, SUITE 210, TACOMA, WA 98405-4964
- **Practice address phone:** (253) 572-8777
- **Practice address fax:** (253) 572-8835
- **Mailing address:** 1812 S J ST, SUITE 210, TACOMA, WA 98405-4964
- **Mailing address phone:** (253) 572-8777
- **Mailing address fax:** (253) 572-8835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2007
- **Last updated:** 12/17/2007