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NPI Code Detail

MEDICARE: WESTERN WASHINGTON MEDICAL GROUP, INC PS

MEDICARE: WESTERN WASHINGTON MEDICAL GROUP, INC PS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1285978882
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTERN WASHINGTON MEDICAL GROUP, INC PS
Provider Business Mailing Address
First Line : 1728 W MARINE VIEW DR
Second Line :
City : EVERETT
State : WA
Zip : 98201-2094
Country : US
Telephone Number : 425-259-4041
Fax Number :
Provider Business Practice Location Address
First Line : 4404 80TH ST NE
Second Line :
City : MARYSVILLE
State : WA
Zip : 98270-3427
Country : US
Telephone Number : 360-659-1231
Fax Number :
Authorized Official
Title or Position : DIRECTOR PFS
Name : KIM HOLSTEIN
Credential :
Telephone Number : 425-259-4041
Provider Enumeration Date : 11/20/2012
Last Update Date : 02/23/2016

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Directions to “WESTERN WASHINGTON MEDICAL GROUP, INC PS ” Practice Location

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