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Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Parent organization
WESTERN WASHINGTON MEDICAL GROUP
Other names
Western Wa Medical Group, Inc Dept of Podiatry
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Authorized official
AMELIA EDENS (DIRECTOR OF PATIENT FINANCIAL SVCS)
(425) 740-4142
Entity
Organization
Contact information
Practice address
3802 BROADWAY STE B, EVERETT, WA 98201-5032
(425) 259-0855
(425) 259-0856
Mailing address
1728 W MARINE VIEW DR STE 110, EVERETT, WA 98201-2094
(425) 259-0855
(425) 259-0856
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
601474013
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0114986
LABOR & INDUSTRIE
WA
05
—
7119019
—
WA
01
—
DA5528
RAILROAD MEDICARE
WA
Enumeration date
04/23/2007
Last updated
08/04/2023
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