Provider Demographics
NPI:1881184356
Name:BLACKBURN &WHITNEY MD PS
Entity Type:Organization
Organization Name:BLACKBURN &WHITNEY MD PS
Other - Org Name:PLASTIC SURGERY BELLINGHAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-676-0972
Mailing Address - Street 1:2500 SQUALICUM PKWY BLDG 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1856
Mailing Address - Country:US
Mailing Address - Phone:360-676-0972
Mailing Address - Fax:360-671-4423
Practice Address - Street 1:2500 SQUALICUM PKWY BLDG 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1856
Practice Address - Country:US
Practice Address - Phone:360-676-0972
Practice Address - Fax:360-671-4423
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACKBURN AND WHITNEY MD PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-10
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and NeckGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty