Provider Demographics
NPI:1265783609
Name:HIGHLINE MEDICAL GROUP
Entity type:Organization
Organization Name:HIGHLINE MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:16122 8TH AVE SW
Mailing Address - Street 2:SUITE E-5
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2967
Mailing Address - Country:US
Mailing Address - Phone:206-241-0824
Mailing Address - Fax:206-243-8002
Practice Address - Street 1:16122 8TH AVE SW
Practice Address - Street 2:SUITE E-5
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2967
Practice Address - Country:US
Practice Address - Phone:206-241-0824
Practice Address - Fax:206-243-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty