Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Parent organization
WESTERN WASHINGTON MEDICAL GROUP
Other names
Western Wa Medical Group Dept of Nephrology
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Authorized official
MS. VICKI MCGINNIS (HIPPA PRIVACY OFFICER)
(425) 259-4041
Entity
Organization
Contact information
Practice address
12728 19TH AVE SE STE 300, EVERETT, WA 98208-6676
(425) 258-6801
(425) 258-1944
Mailing address
12728 19TH AVE SE STE 300, EVERETT, WA 98208-6676
(425) 252-1116
(425) 252-1118
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
601474013
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050081
LABOR & INDUSTRY
WA
05
—
7057029
—
WA
01
—
CJ9333
RAILROAD MEDICARE
WA
Enumeration date
04/23/2007
Last updated
05/24/2024
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