Provider Demographics
NPI:1164972527
Name:OPTUM CARE WASHINGTON PLLC
Entity Type:Organization
Organization Name:OPTUM CARE WASHINGTON PLLC
Other - Org Name:OPTUM - THOMAS LAKE
Other - Org Type:Other Name
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-259-0966
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-304-1100
Mailing Address - Fax:425-304-1102
Practice Address - Street 1:3916 148TH ST SE
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-4751
Practice Address - Country:US
Practice Address - Phone:425-304-1100
Practice Address - Fax:425-304-1102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERETT PHYSICIANS, INC. P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-10
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 208000000X, 332B00000X
WA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory