Provider Demographics
NPI:1831186766
Name:OPTUM CARE WASHINGTON PLLC
Entity type:Organization
Organization Name:OPTUM CARE WASHINGTON PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-258-3900
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-259-0966
Mailing Address - Fax:
Practice Address - Street 1:3901 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4918
Practice Address - Country:US
Practice Address - Phone:425-259-0966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERETT PHYSICIANS, INC. P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-10-05
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 207R00000X, 208000000X, 332B00000X, 261QM1300X
WA50D0662654291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG115128100Medicare PIN
WAG115128200Medicare PIN
0554650007Medicare NSC
WA0554650007Medicare NSC
WAG115116700Medicare PIN
WAG115128000Medicare PIN
WAG115128400Medicare PIN
WAG001252900Medicare PIN
WAG115128300Medicare PIN
WAGAB12742Medicare PIN
WAG115127100Medicare PIN
WAG115151600Medicare PIN
WAGAB02732Medicare PIN
WAGAB13236Medicare PIN
WAG001259300Medicare PIN
WAGAB26705Medicare PIN