Healthcare Provider Details

I. General information

NPI: 1427005313
Provider Name (Legal Business Name): WESTERN WASHINGTON MEDICAL GROUP, INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 BOTHELL EVERETT HWY SUITE 200
EVERETT WA
98208-6642
US

IV. Provider business mailing address

4225 HOYT AVE SUITE A
EVERETT WA
98203-2351
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-3122
  • Fax:
Mailing address:
  • Phone: 425-259-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number601 474 013
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICKI MCGINNIS
Title or Position: HIPAA PRIVACY OFFICER
Credential:
Phone: 425-259-4041