Provider Demographics
NPI:1598294779
Name:WASHINGTON ORTHOPAEDIC CENTER, INC, PS
Entity Type:Organization
Organization Name:WASHINGTON ORTHOPAEDIC CENTER, INC, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-330-1874
Mailing Address - Street 1:1900 COOKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-9073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 LILLY RD SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2115
Practice Address - Country:US
Practice Address - Phone:360-736-2889
Practice Address - Fax:360-736-3136
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WASHINGTON ORTHOPAEDIC CENTER, INC, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-09
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies