Healthcare Provider Details

I. General information

NPI: 1649279852
Provider Name (Legal Business Name): NORTHWEST ORTHOPAEDIC SURGEONS, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 CONTINENTAL PL
MOUNT VERNON WA
98273-4105
US

IV. Provider business mailing address

1500 CONTINENTAL PL
MOUNT VERNON WA
98273-4105
US

V. Phone/Fax

Practice location:
  • Phone: 360-424-7041
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT G BILLOW
Title or Position: PRESIDENT
Credential: D.O.
Phone: 360-424-7041