Basic Information
Provider Information
NPI: 1053563585
EntityType: 2
ReplacementNPI:  
OrganizationName: ORTHOPEDICS INTERNATIONAL
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ORTHOPEDICS INTERNATIONAL AMBULATORY SURGERY CENTER
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 E JEFFERSON ST STE 400
Address2:  
City: SEATTLE
State: WA
PostalCode: 981225647
CountryCode: US
TelephoneNumber: 2063231900
FaxNumber: 2063236868
Practice Location
Address1: 600 BROADWAY STE 460
Address2:  
City: SEATTLE
State: WA
PostalCode: 981225312
CountryCode: US
TelephoneNumber: 2063290585
FaxNumber: 2067090148
Other Information
ProviderEnumerationDate: 10/15/2008
LastUpdateDate: 10/15/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WHALEY
AuthorizedOfficialFirstName: MARY PAT
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CHIEF OPERATING OFFICER
AuthorizedOfficialTelephone: 2063231900
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: COO
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X WAN193200000X MULTI-SPECIALTY GROUPOther Service ProvidersSpecialist 
207X00000X WAN193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansOrthopaedic Surgery 
261QA1903X WAY Ambulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical

No ID Information.


Home