Provider Demographics
NPI:1548324411
Name:KRUGER CLINIC ORTHOPAEDICS, PLLC
Entity type:Organization
Organization Name:KRUGER CLINIC ORTHOPAEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-774-2636
Mailing Address - Street 1:21600 HIGHWAY 99 STE 150
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8047
Mailing Address - Country:US
Mailing Address - Phone:425-774-2636
Mailing Address - Fax:425-774-2688
Practice Address - Street 1:21600 HIGHWAY 99 STE 150
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8047
Practice Address - Country:US
Practice Address - Phone:425-774-2636
Practice Address - Fax:425-774-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB02842Medicare ID - Type UnspecifiedASC MEDICARE NUMBER