Healthcare Provider Details

I. General information

NPI: 1477460202
Provider Name (Legal Business Name): WWC PHYSICIANS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 W TIETAN ST
WALLA WALLA WA
99362-4445
US

IV. Provider business mailing address

55 W TIETAN ST
WALLA WALLA WA
99362-4445
US

V. Phone/Fax

Practice location:
  • Phone: 509-525-3720
  • Fax: 509-522-1592
Mailing address:
  • Phone: 509-525-3720
  • Fax: 509-522-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN MICHELSON
Title or Position: CEO
Credential:
Phone: 509-525-3720