Basic Information
| Provider Information | |||||||||
| NPI: | 1467011122 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON GASTROENTEROLOGY PLLC | ||||||||
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| OtherOrganizationName: | WASHINGTON GASTROENTEROLOGY LAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3006 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984013006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007346855 | ||||||||
| FaxNumber: | 2534040506 | ||||||||
| Practice Location | |||||||||
| Address1: | 33915 1ST WAY S STE 203 | ||||||||
| Address2: | |||||||||
| City: | FEDERAL WAY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980036396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538389839 | ||||||||
| FaxNumber: | 2536619077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2019 | ||||||||
| LastUpdateDate: | 05/06/2021 | ||||||||
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| AuthorizedOfficialLastName: | GORALSKY | ||||||||
| AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2533838342 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WASHINGTON GASTROENTEROLOGY PLLC | ||||||||
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| NPICertificationDate: | 05/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.