Provider Demographics
NPI:1316298789
Name:HIGHLINE MEDICAL GROUP
Entity type:Organization
Organization Name:HIGHLINE MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-439-4887
Mailing Address - Street 1:13030 MILITARY RD S
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3085
Mailing Address - Country:US
Mailing Address - Phone:206-242-6500
Mailing Address - Fax:206-246-7946
Practice Address - Street 1:13030 MILITARY RD S
Practice Address - Street 2:SUITE 210
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3085
Practice Address - Country:US
Practice Address - Phone:206-242-6500
Practice Address - Fax:206-246-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty