# WESTERN WASHINGTON MEDICAL GROUP, INC PS

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WESTERN WASHINGTON MEDICAL GROUP
- **Other names:** Western Wa Medical Group Dept of Endocrinology
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1902024300
- **Legal business name:** WESTERN WASHINGTON MEDICAL GROUP
- **Authorized official:** AMELIA EDENS (DIRECTOR OF PATIENT FINANCIAL SVCS)
- **Authorized official phone:** (425) 740-4142

## Contact information

- **Practice address:** 8423 MUKILTEO SPEEDWAY STE 102, MUKILTEO, WA 98275-3237
- **Practice address phone:** (425) 412-4311
- **Practice address fax:** (425) 374-8896
- **Mailing address:** 1728 W MARINE VIEW DR STE 110, EVERETT, WA 98201-2094
- **Mailing address phone:** (425) 412-4311
- **Mailing address fax:** (425) 374-8896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | 601474013 | WA | Yes |

## Other

- **Enumeration date:** 04/23/2007
- **Last updated:** 08/04/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0101673 | LABOR & INDUSTRY | WA |
| 05 | — | 7106347 | — | WA |
| 01 | — | DA4340 | RAILROAD MEDICARE | WA |