Provider Demographics
NPI:1528266103
Name:EVERETT CARDIOLOGY & ELECTROPHYSIOLOGY, P.S.
Entity type:Organization
Organization Name:EVERETT CARDIOLOGY & ELECTROPHYSIOLOGY, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-261-4910
Mailing Address - Street 1:1330 ROCKEFELLER AVE
Mailing Address - Street 2:225
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-1684
Mailing Address - Country:US
Mailing Address - Phone:425-261-4910
Mailing Address - Fax:425-261-4911
Practice Address - Street 1:1330 ROCKEFELLER AVE
Practice Address - Street 2:225
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1684
Practice Address - Country:US
Practice Address - Phone:425-261-4910
Practice Address - Fax:425-261-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022810207RC0001X, 261QM2500X, 207RC0000X
WAPA10004886207RC0001X, 207RC0000X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8435968OtherDSHS J.MATISTA
WA1005040OtherDSHS J. ROSE
WA1396749701OtherNPI, J.ROSE
WA363A00000XOtherTAXONOMY, J.MATISTA
WA1366435943OtherNPI, J.MATISTA
WA207RC0000XOtherTAXONOMY, J.ROSE
WA1396749701OtherNPI, J.ROSE
WA207RC0000XOtherTAXONOMY, J.ROSE
WAA49547Medicare UPIN
WA8854567Medicare PIN
WAG8854566Medicare PIN