Provider Demographics
NPI:1568713949
Name:HIGHLINE MEDICAL GROUP
Entity Type:Organization
Organization Name:HIGHLINE MEDICAL GROUP
Other - Org Name:ROXBURY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-439-4887
Mailing Address - Street 1:9635 17TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2712
Mailing Address - Country:US
Mailing Address - Phone:206-763-5057
Mailing Address - Fax:206-763-5241
Practice Address - Street 1:9635 17TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2712
Practice Address - Country:US
Practice Address - Phone:206-763-5057
Practice Address - Fax:206-763-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty