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General NPI Number Information
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NPI Number | 1568916682
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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 | 08/05/2016
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Last Update Date | 06/19/2024
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Provider Practice Location Address
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Address Line | 12728 19TH AVE SE SUITE 300
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City | EVERETT
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State | WA
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Zip | 98208-6526
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Country | US
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Telephone | 425-259-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 1728 W MARINE VIEW DR SUITE 110
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City | EVERETT
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State | WA
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Zip | 98201-2094
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Country | US
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Telephone | 425-259-4041
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Fax |
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Authorized Official
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Title or Position | CONTRACT ANALYST/CREDENTIALING COOR
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Name | ELIZABETH BAE
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Credential |
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Telephone | 425-259-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084A2900X
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Taxonomy Name | Neurocritical Care Physician
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License Number |
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License Number State |
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