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General NPI Number Information
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NPI Number | 1225911829
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Entity Type | Organization
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Legal Business Name | PRIVIA MEDICAL GROUP WASHINGTON, PLLC
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 702 S PARK ST STE A
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City | DEER PARK
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State | WA
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Zip | 99006-7025
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Country | US
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Telephone | 509-262-9000
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Fax | 509-276-3034
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Provider Business Mailing Address
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Address Line | 55 W TIETAN ST
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City | WALLA WALLA
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State | WA
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Zip | 99362-4445
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | EDWARD FARGIS
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Credential |
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Telephone | 571-366-8850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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