Provider Demographics
NPI:1164555652
Name:LYNNWOOD MEDICAL CENTER, INCORPORATED, P.S.
Entity Type:Organization
Organization Name:LYNNWOOD MEDICAL CENTER, INCORPORATED, P.S.
Other - Org Name:LYNNWOOD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:CODAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:425-776-8414
Mailing Address - Street 1:19720 68TH AVE W
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4568
Mailing Address - Country:US
Mailing Address - Phone:425-776-8414
Mailing Address - Fax:425-672-1084
Practice Address - Street 1:19720 68TH AVE W
Practice Address - Street 2:SUITE B
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4568
Practice Address - Country:US
Practice Address - Phone:425-776-8414
Practice Address - Fax:425-672-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0165879OtherDEPT. LABOR & INDUSTRIES
WA7075575Medicaid
AB35027Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER