Healthcare Provider Details

I. General information

NPI: 1538435615
Provider Name (Legal Business Name): WESTERN WASHINGTON CARDIOLOGY TRUST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S 13TH ST SUITE 300
MOUNT VERNON WA
98274-4100
US

IV. Provider business mailing address

12728 19TH AVE SE SUITE 200
EVERETT WA
98208-6526
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-9757
  • Fax:
Mailing address:
  • Phone: 425-525-2700
  • Fax: 425-525-2790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES WILLIAM SCHNEIDER
Title or Position: CEO
Credential:
Phone: 206-368-5934