MEDICARE: EASTSIDE ORTHOPEDICS & SPORTS

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number	:	1447202247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE ORTHOPEDICS & SPORTS

Provider Business Mailing Address
First Line	:	1601 116TH AVE NE
Second Line	:	SUITE #111
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3010
Country	:	US
Telephone Number	:	425-990-8300
Fax Number	:	425-990-8311

Provider Business Practice Location Address
First Line	:	1601 116TH AVE NE
Second Line	:	SUITE #111
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3010
Country	:	US
Telephone Number	:	425-990-8300
Fax Number	:	425-990-8311

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	VINCENT M SANTORO
Credential	:	MD
Telephone Number	:	425-990-8300

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	08/22/2020

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Directions to “EASTSIDE ORTHOPEDICS & SPORTS ” Practice Location

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