Healthcare Provider Details

I. General information

NPI: 1821787334
Provider Name (Legal Business Name): OPA ORTHO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 BROADWAY # 700
SEATTLE WA
98122-5330
US

IV. Provider business mailing address

601 BROADWAY # 700
SEATTLE WA
98122-5330
US

V. Phone/Fax

Practice location:
  • Phone: 206-386-2600
  • Fax: 206-622-1644
Mailing address:
  • Phone: 206-386-2600
  • Fax: 206-622-1644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA J PRICE
Title or Position: OPERATIONS SUPERVISOR
Credential:
Phone: 206-518-6311