Provider Demographics
NPI:1376716597
Name:STRAIT ORTHOPEDIC SPECIALISTS, PS
Entity Type:Organization
Organization Name:STRAIT ORTHOPEDIC SPECIALISTS, PS
Other - Org Name:MCGOVERN THERAPY SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-417-8630
Mailing Address - Street 1:1112 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-4204
Mailing Address - Country:US
Mailing Address - Phone:360-417-8630
Mailing Address - Fax:360-417-8635
Practice Address - Street 1:520 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3079
Practice Address - Country:US
Practice Address - Phone:360-417-8630
Practice Address - Fax:360-417-8635
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRAIT ORTHOPEDIC SPECIALISTS, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038097207XS0114X
WAOT00003652225X00000X
WAPA10005046363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA147288OtherDEPT. OF LABOR & INDUSTRI
WACH7730OtherRAILROAD MEDICARE
WA7105810Medicaid
WA7682677Medicaid
WA7682677Medicaid