Provider Demographics
NPI:1275734691
Name:MADRONA MEDICAL GROUP P.S. DME
Entity Type:Organization
Organization Name:MADRONA MEDICAL GROUP P.S. DME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDMARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-738-3300
Mailing Address - Street 1:4545 CORDATA PKWY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7123
Mailing Address - Country:US
Mailing Address - Phone:360-738-3300
Mailing Address - Fax:360-752-5673
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7123
Practice Address - Country:US
Practice Address - Phone:360-738-3300
Practice Address - Fax:360-752-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies