NPIMap

Organization Active NPI

Privia Medical Group Washington, PLLC

  • Durable Medical Equipment & Medical Supplies
  • Deer Park, WA
National Provider Identifier
1124998943
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
PRIVIA MEDICAL GROUP WASHINGTON, PLLC
Practice address
905 E D St
Deer Park, WA 99006-5167
Phone
(509) 276-5005
Fax
(509) 276-7785
NPI assigned
Nov 6, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Edward Fargis
Title
General Counsel
Phone
(571) 366-8850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

905 E D St
Deer Park, WA 99006-5167

Mailing address

905 E D St
Deer Park, WA 99006-5167
Phone (509) 276-5005

National Provider Directory

National Provider Directory
Tax ID family
Walla Walla Clinic Surg7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762387200000",
    "number": "1124998943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "905 E D ST",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990065167",
            "telephone_number": "509-276-5005",
            "fax_number": "509-276-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E D ST",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990065167",
            "telephone_number": "509-276-5005",
            "fax_number": "509-276-7785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVIA MEDICAL GROUP WASHINGTON, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-11-06",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A",
        "authorized_official_last_name": "FARGIS",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "571-366-8850"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.