Provider Demographics
NPI:1215091368
Name:KRUGER CLINIC ORTHOPAEDICS, PLLC
Entity type:Organization
Organization Name:KRUGER CLINIC ORTHOPAEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-774-2636
Mailing Address - Street 1:21600 HWY 99 STE 150
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026
Mailing Address - Country:US
Mailing Address - Phone:425-774-2636
Mailing Address - Fax:425-774-2688
Practice Address - Street 1:21600 HWY 99 STE 150
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-774-2636
Practice Address - Fax:425-774-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
WA601850391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB02691Medicare PIN
WAAB02691Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
WA0520500001Medicare NSC