Provider Demographics
NPI:1568523959
Name:MEDICAL CENTER OF ORTING INC PC
Entity Type:Organization
Organization Name:MEDICAL CENTER OF ORTING INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMAD
Authorized Official - Middle Name:NABIL
Authorized Official - Last Name:GIRGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PCP
Authorized Official - Phone:360-893-2266
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-0669
Mailing Address - Country:US
Mailing Address - Phone:360-893-2266
Mailing Address - Fax:360-893-2821
Practice Address - Street 1:122 WASHINGTON AVE S
Practice Address - Street 2:
Practice Address - City:ORTING
Practice Address - State:WA
Practice Address - Zip Code:98360-9802
Practice Address - Country:US
Practice Address - Phone:360-893-2266
Practice Address - Fax:360-893-2821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAW002493OtherCHAMPUS
WA7000995Medicaid
WAMO7242OtherREGENCE
WACS5845OtherRAILROAD MEDICARE
WAW002493OtherCHAMPUS
WAMO7242OtherREGENCE