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
1	261QE0800X	Endoscopy Clinic/Center	601 474 013	WA
2	261QA1903X	Ambulatory Surgical Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	490002852	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0150248	OTHER	WA	LABOR AND INDUSTRY

General Provider Information

NPI Number	:	1427005313
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN WASHINGTON MEDICAL GROUP, INC PS

Provider Business Mailing Address
First Line	:	4225 HOYT AVE
Second Line	:	SUITE A
City	:	EVERETT
State	:	WA
Zip	:	98203-2351
Country	:	US
Telephone Number	:	425-259-3122
Fax Number	:

Provider Business Practice Location Address
First Line	:	12800 BOTHELL EVERETT HWY
Second Line	:	SUITE 200
City	:	EVERETT
State	:	WA
Zip	:	98208-6642
Country	:	US
Telephone Number	:	425-259-3122
Fax Number	:

Authorized Official
Title or Position	:	HIPAA PRIVACY OFFICER
Name	:	VICKI MCGINNIS
Credential	:
Telephone Number	:	425-259-4041

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	02/23/2016

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

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