Provider Demographics
NPI:1629008081
Name:WASHINGTON ORTHOPEDICS AND SPORTS MEDICINE, PC
Entity type:Organization
Organization Name:WASHINGTON ORTHOPEDICS AND SPORTS MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-814-8514
Mailing Address - Street 1:11821 NE 128TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7210
Mailing Address - Country:US
Mailing Address - Phone:425-823-8282
Mailing Address - Fax:425-823-6696
Practice Address - Street 1:11821 NE 128TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7210
Practice Address - Country:US
Practice Address - Phone:425-823-8282
Practice Address - Fax:425-823-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030689207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0053352OtherL&I GROUP
WA7040033Medicaid
WA5677DEOtherREGENCE GROUP WRITER
WAD13564Medicare UPIN