Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Parent organization
WESTERN WASHINGTON MEDICAL GROUP
Other names
Western Wa Medical Group Dept of Urology
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Authorized official
MS. VICKI MCGINNIS (PRIVACY OFFICER)
(425) 259-4041
Entity
Organization
Contact information
Practice address
4310 COLBY AVE STE 203, EVERETT, WA 98203-2338
(425) 252-8102
(425) 339-0835
Mailing address
4310 COLBY AVE STE 203, EVERETT, WA 98203-2338
(425) 252-8102
(425) 339-0835
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
601474013
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0050030
LABOR & INDUSTRY
WA
05
—
7056955
—
WA
01
—
CG3610
RAILROAD MEDICARE
WA
Enumeration date
04/23/2007
Last updated
02/23/2016
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