MEDICARE: OLYMPIA OBSTETRICS & GYNECOLOGY PLLC

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	207V00000X	Obstetrics & Gynecology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	G8854429	OTHER	WA	MEDICARE PTAN

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

General Provider Information

NPI Number	:	1922045848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLYMPIA OBSTETRICS & GYNECOLOGY PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1008
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98507-1008
Country	:	US
Telephone Number	:	360-413-8413
Fax Number	:	360-413-8879

Provider Business Practice Location Address
First Line	:	615 LILLY RD NE STE 200
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-5137
Country	:	US
Telephone Number	:	360-413-8413
Fax Number	:	360-413-7143

Authorized Official
Title or Position	:	PARTNER
Name	:	LAURIE T SORENSON
Credential	:	MD
Telephone Number	:	360-413-8413

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/16/2022

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Directions to “OLYMPIA OBSTETRICS & GYNECOLOGY PLLC ” Practice Location

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