MEDICARE: U.S. HEALTHWORKS MEDICAL GROUP OF WASHINGTON, PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083X0100X	Occupational Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1114478864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	U.S. HEALTHWORKS MEDICAL GROUP OF WASHINGTON, PS

Provider Business Mailing Address
First Line	:	25124 SPRINGFIELD CT
Second Line	:	SUITE 200
City	:	VALENCIA
State	:	CA
Zip	:	91355-1085
Country	:	US
Telephone Number	:	661-678-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	6720 FORT DENT WAY
Second Line	:	SUITE 110
City	:	TUKWILA
State	:	WA
Zip	:	98188-8508
Country	:	US
Telephone Number	:	206-242-3651
Fax Number	:	206-433-7946

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. JOSEPH T MALLAS
Credential	:
Telephone Number	:	661-678-2600

Provider Enumeration Date	:	10/18/2016
Last Update Date	:	10/18/2016

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