Provider Demographics
NPI:1497749642
Name:WESTERN WASHINGTON ONCOLOGY PS
Entity Type:Organization
Organization Name:WESTERN WASHINGTON ONCOLOGY PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:EDGINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-754-3934
Mailing Address - Street 1:4525 3RD AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1010
Mailing Address - Country:US
Mailing Address - Phone:360-754-3934
Mailing Address - Fax:
Practice Address - Street 1:4525 3RD AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1010
Practice Address - Country:US
Practice Address - Phone:360-754-3934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7086648Medicaid