Provider Demographics
NPI:1598963209
Name:OLYMPIC MEDICAL PHYSICIANS
Entity Type:Organization
Organization Name:OLYMPIC MEDICAL PHYSICIANS
Other - Org Name:OMP ORTHOPAEDIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-417-7705
Mailing Address - Street 1:1004 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-3902
Mailing Address - Country:US
Mailing Address - Phone:360-457-1500
Mailing Address - Fax:360-457-1599
Practice Address - Street 1:1004 CAROLINE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3902
Practice Address - Country:US
Practice Address - Phone:360-457-1500
Practice Address - Fax:360-457-1599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAH038207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherFEDERAL TAX ID NUMBER