Basic Information
| Provider Information | |||||||||
| NPI: | 1528266103 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVERETT CARDIOLOGY & ELECTROPHYSIOLOGY, P.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1330 ROCKEFELLER AVE | ||||||||
| Address2: | 225 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252614910 | ||||||||
| FaxNumber: | 4252614911 | ||||||||
| Practice Location | |||||||||
| Address1: | 1330 ROCKEFELLER AVE | ||||||||
| Address2: | 225 | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252614910 | ||||||||
| FaxNumber: | 4252614911 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 11/19/2007 | ||||||||
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| AuthorizedOfficialLastName: | ROSE | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | STEVEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN, PART OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4252614910 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0001X | MD00022810 | WA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | PA10004886 | WA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0000X | PA10004886 | WA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 261QM2500X | MD00022810 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 261QM2500X | PA10004886 | WA | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 207RC0000X | MD00022810 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 8435968 | 01 | WA | DSHS J.MATISTA | OTHER | 1005040 | 01 | WA | DSHS J. ROSE | OTHER | 1396749701 | 01 | WA | NPI, J.ROSE | OTHER | 363A00000X | 01 | WA | TAXONOMY, J.MATISTA | OTHER | 1366435943 | 01 | WA | NPI, J.MATISTA | OTHER | 207RC0000X | 01 | WA | TAXONOMY, J.ROSE | OTHER |