Healthcare Provider Details

I. General information

NPI: 1548324411
Provider Name (Legal Business Name): KRUGER CLINIC ORTHOPAEDICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 HIGHWAY 99 STE 150
EDMONDS WA
98026-8047
US

IV. Provider business mailing address

21600 HIGHWAY 99 STE 150
EDMONDS WA
98026-8047
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-2636
  • Fax: 425-774-2688
Mailing address:
  • Phone: 425-774-2636
  • Fax: 425-774-2688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENDA MITCHELL
Title or Position: BILLING MANAGER
Credential:
Phone: 425-774-2636