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General NPI Number Information
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NPI Number | 1528370723
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Entity Type | Organization
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Legal Business Name | WESTERN WASHINGTON MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/06/2010
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Provider Practice Location Address
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Address Line | 3726 BROADWAY STE 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 STE 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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Authorized Official
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Title or Position | CEO
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Name | MR. JERRY TILLINGER
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Credential | CEO
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Telephone | 425-740-4149
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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