Organization
NORTHWEST CARDIOVASCULAR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLENDA LEE MEDEEN (BUSINESS MANAGER)
(253) 572-8777
Entity
Organization
Contact information
Practice address
1812 S J ST, SUITE 210, TACOMA, WA 98405-4964
(253) 572-8777
(253) 572-8835
Mailing address
1812 S J ST, SUITE 210, TACOMA, WA 98405-4964
(253) 572-8777
(253) 572-8835
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7129372
—
WA
Enumeration date
03/22/2007
Last updated
12/17/2007
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