Healthcare Provider Details

I. General information

NPI: 1598294779
Provider Name (Legal Business Name): WASHINGTON ORTHOPAEDIC CENTER, INC, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 LILLY RD SE
OLYMPIA WA
98501-2115
US

IV. Provider business mailing address

1900 COOKS HILL RD
CENTRALIA WA
98531-9073
US

V. Phone/Fax

Practice location:
  • Phone: 360-736-2889
  • Fax: 360-736-3136
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TABITHA NORTHRUP
Title or Position: ADMINISTRATOR
Credential:
Phone: 360-330-1874