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General NPI Number Information
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NPI Number | 1376761775
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Entity Type | Organization
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Legal Business Name | WESTERN WASHINGTON MEDICAL GROUP, INC PS
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 3726 BROADWAY SUITE 201
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City | EVERETT
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State | WA
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Zip | 98201-3788
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Country | US
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Telephone | 425-317-9119
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Fax | 425-317-9118
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Provider Business Mailing Address
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Address Line | 3726 BROADWAY SUITE 201
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City | EVERETT
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State | WA
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Zip | 98201-3787
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Country | US
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Telephone | 425-317-9119
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Fax | 425-317-9118
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Authorized Official
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Title or Position | PM SYSTEM ADMINISTRATOR
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Name | MS. VICKI M MCGINNIS
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Credential |
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Telephone | 425-740-4148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 601474013
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License Number State | WA
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