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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1689787103
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	:	360-736-2889
Fax Number	:	360-736-9777

Provider Business Practice Location Address
First Line	:	1900 COOKS HILL RD
Second Line	:
City	:	CENTRALIA
State	:	WA
Zip	:	98531-9073
Country	:	US
Telephone Number	:	360-736-2889
Fax Number	:	360-736-9777

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	WANDA GARZA
Credential	:
Telephone Number	:	360-330-1891

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	09/22/2009

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