WESTERN WASHINGTON MEDICAL GROUP, INC PS (NPI# 1003809229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003809229 |
| Entity Type | Organization |
| Organization Name | WESTERN WASHINGTON MEDICAL GROUP, INC PS |
| Other Organization Name | LAKE SERENE CLINIC |
| Practice Address |
3501 Shelby Rd Suite B Lynnwood WA 98087-3599 |
| Practice Telephone | 4257429119 |
| Mailing Telephone | 4257429119 |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2016-02-23 |
| Authorized Official Name | MR. COREY DON FRIESEN (CEO ADMINISTRATOR) |
| Authorized Official Telephone | 4257429119 |
| Is Organization Subpart | Y |
| Parent Organization Name | WESTERN WASHINGTON MEDICAL GROUP, INC PS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Lake Serene Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023236528 | Western Washington Medical Group, Inc Ps | Internal Medicine | 4225 Hoyt Ave Ste A, Everett, WA 98203-2351 | 2007-04-23 |
| 1649498049 | Western Washington Medical Group, Inc Ps | Family Medicine | 4225 Hoyt Ave Ste B, Everett, WA 98203-2351 | 2007-04-23 |
| 1932327335 | Western Washington Medical Group, Inc Ps | Podiatrist | 3202 Colby Ave Ste E, Everett, WA 98201-4324 | 2007-04-23 |
| 1326266727 | Western Washington Medical Group, Inc Ps | Psychologist | 3525 Colby Ave Ste 200, Everett, WA 98201-4782 | 2007-04-23 |
| 1538387931 | Western Washington Medical Group, Inc Ps | Urology | 4310 Colby Ave Ste 203, Everett, WA 98203-2338 | 2007-04-23 |
| 1093933491 | Western Washington Medical Group, Inc Ps | Internal Medicine | 1330 Rockefeller Ave Ste 330, Everett, WA 98201 | 2007-04-23 |
| 1417175811 | Western Washington Medical Group, Inc Ps | Internal Medicine | 1330 Rockefeller Ave Ste 450, Everett, WA 98201-1677 | 2007-04-23 |
| 1831238443 | Western Washington Medical Group, Inc Ps | Spec/Tech, Pathology | 6825 216th St Sw Ste E, Lynnwood, WA 98036-7379 | 2007-02-06 |
| 1538606413 | Western Washington Medical Group, Inc Ps | Internal Medicine | 1909 214th St Se, Suite 211, Bothell, WA 98021-4412 | 2017-01-30 |
| 1568916682 | Western Washington Medical Group, Inc Ps | Psychiatry & Neurology | 12728 19th Ave Se, Suite 300, Everett, WA 98208-6526 | 2016-08-05 |
| Street Address |
3501 SHELBY RD SUITE B |
| City | LYNNWOOD |
| State | WA |
| Zip Code | 98087-3599 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740458686 | Renee Lynne Davis | Specialist | 3501 Shelby Rd, Suite C, Lynnwood, WA 98087-3599 | 2008-02-13 |
| 1306022579 | Christy R Knutson | Specialist | 3501 Shelby Rd, Suite C, Lynnwood, WA 98087-3599 | 2008-01-17 |
| 1316128622 | Andrew R Kruse | Nurse Practitioner | 3501 Shelby Rd, Suite B, Lynnwood, WA 98087-3599 | 2007-11-15 |
| 1619003316 | Serene Lake Massage Therapy | Specialist | 3501 Shelby Rd, Suite C, Lynnwood, WA 98087-3599 | 2007-02-26 |
| 1346398823 | Chad Eric Triplett | Specialist | 3501 Shelby Rd, Suite C, Lynnwood, WA 98087-3599 | 2007-01-08 |
| 1063405017 | Joshua Michael Webb | Registered Nurse | 3501 Shelby Rd, Suite B, Lynnwood, WA 98087-3599 | 2005-08-24 |
| 1750374799 | Andrea Lynn Friesen | Registered Nurse | 3501 Shelby Rd, Suite B, Lynnwood, WA 98087-3599 | 2005-08-24 |
| 1962495903 | Gregory Alan Lind | Registered Nurse | 3501 Shelby Rd, Suite B, Lynnwood, WA 98087-3599 | 2005-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568022341 | Romina Kim | Behavioral Analyst | 14228 26th Ave W, Unit A, Lynnwood, WA 98087 | 2019-06-14 |
| 1710542048 | Dwight Hendricks | Massage Therapist | 2902 164th Street Sw, Suite D1, Lynnwood, WA 98087 | 2019-05-02 |
| 1134603822 | Pamela C Brown-seely | Counselor | 15914 44th Ave W, M-208, Lynnwood, WA 98087 | 2018-09-19 |
| 1699213678 | Kyra Ripley | Counselor | 13821 Beverly Park Rd, Lynnwood, WA 98087 | 2017-02-09 |
| 1144634411 | Gloria Orias | Contractor | 14421 Ash Way, Lynnwood, WA 98087 | 2014-06-16 |
| 1134548316 | Nguyen & Nguyen Dds, Pllc | Clinic/Center | 15620 Highway 99, Suite 4, Lynnwood, WA 98087 | 2014-04-15 |
| 1659526341 | Hee-jin Yang | Dentist | 1418 164th St Sw Ste 100, Lynnwood, WA 98087 | 2008-11-21 |
| 1972795342 | Linda Marie Bowen | Counselor | 1120 164th St Sw, Lynnwood, WA 98087 | 2007-08-09 |
| 1649475799 | Martha Lake Dental Center | Dentist | 1233 164th St Sw, Ste #h, Lynnwood, WA 98087 | 2007-06-19 |
| 1154532042 | Atlas Chiropractic Clinic, LLC | Chiropractor | 14608 Hwy 99 Suite309, Lynnwood, WA 98087 | 2007-05-24 |
| Find all providers in zip 98087 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
| 1740502731 | Stanley D Borish Md Inc Ps | Clinic/Center | 19526 64th Ave W, Lynnwood, WA 98036-5100 | 2010-02-18 |
| 1841658374 | Vagabond Medicine Pllc | Clinic/Center | 16521 13th Ave W, Suite #105, Lynnwood, WA 98037-8528 | 2016-01-28 |
| 1235422452 | Sound Health Physicians Ps | Clinic/Center | 18631 Alderwood Mall Pkwy, Suite 304, Lynnwood, WA 98037-8014 | 2011-05-20 |
| 1164555652 | Lynnwood Medical Center, Incorporated, P.s. | Clinic/Center | 19720 68th Ave W, Suite B, Lynnwood, WA 98036-4568 | 2007-03-13 |
| 1184751638 | Edmonds Family Care, Pllc | Clinic/Center | 6101 200th St Sw, Ste#208, Lynnwood, WA 98036-6077 | 2007-02-28 |
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| 1013550987 | Rejuventa Medical Corp. | Clinic/Center | 107 North Tower Ave Suite 17, Centralia, WA 98531-4253 | 2019-10-23 |
| 1023668407 | Vera Whole Health Wa, PC | Clinic/Center | 4933 Evergreen Way, Everett, WA 98203-2828 | 2019-09-17 |
| 1679042501 | Family and Wellness Medicine | Clinic/Center | 34004 16th Ave S Ste 100, Federal Way, WA 98003-8905 | 2018-11-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.