Healthcare Provider Details

I. General information

NPI: 1528266103
Provider Name (Legal Business Name): EVERETT CARDIOLOGY & ELECTROPHYSIOLOGY, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 ROCKEFELLER AVE 225
EVERETT WA
98201-1684
US

IV. Provider business mailing address

1330 ROCKEFELLER AVE 225
EVERETT WA
98201-1684
US

V. Phone/Fax

Practice location:
  • Phone: 425-261-4910
  • Fax: 425-261-4911
Mailing address:
  • Phone: 425-261-4910
  • Fax: 425-261-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00022810
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberPA10004886
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD00022810
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberPA10004886
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberMD00022810
License Number StateWA
# 6
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberPA10004886
License Number StateWA

VIII. Authorized Official

Name: DR. JEFFREY STEVEN ROSE
Title or Position: PHYSICIAN, PART OWNER
Credential: M.D.
Phone: 425-261-4910