Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Parent organization
WESTERN WASHINGTON MEDICAL GROUP
Other names
Western Washington Medical Group Endoscopy Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Authorized official
VICKI MCGINNIS (HIPAA PRIVACY OFFICER)
(425) 259-4041
Entity
Organization
Contact information
Practice address
12800 BOTHELL EVERETT HWY, SUITE 200, EVERETT, WA 98208-6642
(425) 259-3122
Mailing address
4225 HOYT AVE, SUITE A, EVERETT, WA 98203-2351
(425) 259-3122
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QE0800X
Endoscopy Clinic/Center
601 474 013
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0150248
LABOR AND INDUSTRY
WA
01
—
490002852
RAILROAD MEDICARE
WA
05
—
7068356
—
WA
Enumeration date
05/27/2006
Last updated
02/23/2016
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