Provider Demographics
NPI:1730289596
Name:WHITMAN MEDICAL GROUP PS
Entity Type:Organization
Organization Name:WHITMAN MEDICAL GROUP PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HYMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-397-4717
Mailing Address - Street 1:1210 W FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-9552
Mailing Address - Country:US
Mailing Address - Phone:509-397-4717
Mailing Address - Fax:509-397-3501
Practice Address - Street 1:1210 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-9552
Practice Address - Country:US
Practice Address - Phone:509-397-4717
Practice Address - Fax:509-397-3501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7062987Medicaid
WA0946290001OtherPTAN
WA0946290001OtherPTAN
WA0946290001Medicare NSC