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General NPI Number Information
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NPI Number | 1629024740
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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 | 05/26/2006
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Last Update Date | 02/23/2016
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Provider Practice Location Address
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Address Line | 4301 HOYT AVE SUITE B
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City | EVERETT
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State | WA
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Zip | 98203-2316
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Country | US
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Telephone | 425-257-9997
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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 111
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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 | 425-740-4177
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Fax | 425-252-6642
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Authorized Official
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Title or Position | PRIVACY OFFICER
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Name | VICKI M MCGINNIS
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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 | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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