Provider Demographics
NPI:1992861256
Name:MOUNTAIN ORTHOPAEDIC SPECIALISTS INC
Entity type:Organization
Organization Name:MOUNTAIN ORTHOPAEDIC SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-752-0714
Mailing Address - Street 1:1550 S UNION AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1946
Mailing Address - Country:US
Mailing Address - Phone:253-752-0714
Mailing Address - Fax:253-761-2451
Practice Address - Street 1:1550 S UNION AVE
Practice Address - Street 2:STE 210
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1946
Practice Address - Country:US
Practice Address - Phone:253-752-0714
Practice Address - Fax:253-761-2451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031853207X00000X
WAMD00035040207X00000X, 207XS0106X
261QM2500X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7113582Medicaid
WA162783OtherDEPT OF LABOR & INDUSTRIE
WA162783OtherDEPT OF LABOR & INDUSTRIE
WA7113582Medicaid
WAAB32505Medicare ID - Type Unspecified