Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Parent organization
WESTERN WASHINGTON MEDICAL GROUP
Other names
Western Wa Medical Group Dept of Orthopedics
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Authorized official
MS. VICKI M MCGINNIS (PM SYSTEM ADMINISTRATOR)
(425) 740-4148
Entity
Organization
Contact information
Practice address
3726 BROADWAY, SUITE 201, EVERETT, WA 98201-3788
(425) 317-9119
(425) 317-9118
Mailing address
3726 BROADWAY, SUITE 201, EVERETT, WA 98201-3787
(425) 317-9119
(425) 317-9118
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
601474013
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0036257
LABOR & INDUSTRY
WA
01
—
0728350005
NPI
—
05
—
7067648
—
WA
01
—
CQ2138
RAILROAD MEDICARE
WA
Enumeration date
04/23/2007
Last updated
02/23/2016
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