Provider Demographics
NPI:1275713299
Name:MATTHEW WHITE MD PS
Entity Type:Organization
Organization Name:MATTHEW WHITE MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-584-1700
Mailing Address - Street 1:5920 100TH ST SW STE 30
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2751
Mailing Address - Country:US
Mailing Address - Phone:253-584-1700
Mailing Address - Fax:253-581-1740
Practice Address - Street 1:5920 100TH ST SW STE 30
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2751
Practice Address - Country:US
Practice Address - Phone:253-584-1700
Practice Address - Fax:253-581-1740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7107741Medicaid
WA7107741Medicaid