Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Parent organization
WESTERN WASHINGTON MEDICAL GROUP
Other names
Western Washington Medical Group Department of Laboratory Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
WESTERN WASHINGTON MEDICAL GROUP
Authorized official
VICKI M MCGINNIS (PRIVACY OFFICER)
(425) 259-4041
Entity
Organization
Contact information
Practice address
4301 HOYT AVE, SUITE B, EVERETT, WA 98203-2316
(425) 257-9997
Mailing address
1728 W MARINE VIEW DR, SUITE 111, EVERETT, WA 98201-2094
(425) 740-4177
(425) 252-6642
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0188172
LABOR AND INDUSTRY
WA
05
—
7124795
—
WA
01
—
P00162700
RR MEDICARE
—
Enumeration date
05/26/2006
Last updated
02/23/2016
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