Healthcare Provider Details

I. General information

NPI: 1689787103
Provider Name (Legal Business Name): WASHINGTON ORTHOPAEDIC CENTER, INC., PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

IV. Provider business mailing address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2889
  • Fax: 360-736-9777
Mailing address:
  • Phone: 360-736-2889
  • Fax: 360-736-9777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: WANDA GARZA
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 360-330-1891