Organization
WESTERN WASHINGTON MEDICAL GROUP, INC PS
Active
Parent organization
WESTERN WASHINGTON MEDICAL GROUP
Other names
Western Wa Medical Group Dept of Cardiology
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
12728 19TH AVE SE, SUITE 200, EVERETT, WA 98208-6526
(425) 261-3430
(425) 261-3435
Mailing address
1728 W MARINE VIEW DR, SUITE 110, EVERETT, WA 98201-2094
(425) 259-4041
(425) 261-3435
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
601474013
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0067760
LABOR & INDUSTRIE
WA
05
—
7081870
—
WA
01
—
CE7385
RAILROAD MEDICARE
WA
Enumeration date
04/23/2007
Last updated
10/13/2016
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