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 Gastroenterology
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Authorized official
MS. VICKI MCGINNIS (HIPAA PRIVACY OFFICER)
(425) 259-4041
Entity
Organization
Contact information
Practice address
4225 HOYT AVE STE A, EVERETT, WA 98203-2351
(425) 259-3122
(425) 252-9860
Mailing address
4225 HOYT AVE STE A, EVERETT, WA 98203-2351
(425) 259-3122
(425) 252-9860
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
601474013
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050070
LABOR & INDUSTRIE
WA
05
—
7056971
—
WA
01
—
CB4745
RAILROAD MEDICARE
WA
Enumeration date
04/23/2007
Last updated
02/23/2016
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