MEDICARE: WASHINGTON ORTHOPAEDIC CENTER, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1598294779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON ORTHOPAEDIC CENTER, INC, PS

Provider Business Mailing Address
First Line	:	1900 COOKS HILL RD
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-9073
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 LILLY RD SE
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-2115
Country	:	US
Telephone Number	:	360-736-2889
Fax Number	:	360-736-3136

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	TABITHA NORTHRUP
Credential	:
Telephone Number	:	360-330-1874

Provider Enumeration Date	:	06/09/2017
Last Update Date	:	03/20/2019

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