MEDICARE: MULTI MED MANAGEMENT CORP

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	208D00000X	General Practice Physician	MD00019249	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	602980301	OTHER	WA	UBI NUMBER

General Provider Information

NPI Number	:	1992107130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MULTI MED MANAGEMENT CORP

Provider Business Mailing Address
First Line	:	205 STEWART RD
Second Line	:	SUITE 104
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-9607
Country	:	US
Telephone Number	:	360-416-3322
Fax Number	:	260-707-7103

Provider Business Practice Location Address
First Line	:	205 STEWART RD
Second Line	:	SUITE 104
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-9607
Country	:	US
Telephone Number	:	360-416-3322
Fax Number	:	260-707-7103

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PHILIP A WARD
Credential	:
Telephone Number	:	360-416-3322

Provider Enumeration Date	:	09/18/2014
Last Update Date	:	09/18/2014

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Directions to “MULTI MED MANAGEMENT CORP ” Practice Location

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