Ownership: Washington's professional service corporation law (RCW 18.100) lets licensed health care professionals from listed professions jointly own one professional service corporation, and a Washington Medical Commission policy notes that most clinics are owned by organizations other than physicians or PAs and that dictating medical practice to an employed physician would be an ethical breach.
Certificate of need: Washington's Department of Health runs a Certificate of Need program covering hospitals, nursing homes, kidney dialysis centers, Medicare or Medicaid home health and hospice agencies, hospice care centers, ambulatory surgical centers and certain tertiary services.
Nurse practitioners: AANP classifies Washington as full practice, and its state fact sheet lists no transition-to-practice requirement.
Who can own a medical clinic in Washington
Washington's professional service corporation law (RCW 18.100) lets licensed health care professionals from listed professions jointly own one professional service corporation, and a Washington Medical Commission policy notes that most clinics are owned by organizations other than physicians or PAs and that dictating medical practice to an employed physician would be an ethical breach. We could not find a clear official statement on whether non-physicians can own a medical practice in Washington, so confirm the structure with a healthcare attorney.
Sources: app.leg.wa.gov, wmc.wa.gov
Business entity and registration
Physicians commonly form a professional service corporation under RCW 18.100, owned by professionals licensed to render the same services (with an exception letting listed health care professions co-own one corporation). Entities are filed with the Washington Secretary of State Corporations and Charities Division through the Corporations and Charities Filing System (CCFS).
Sources: app.leg.wa.gov, sos.wa.gov
Certificate of need in Washington
Washington's Department of Health runs a Certificate of Need program covering hospitals, nursing homes, kidney dialysis centers, Medicare or Medicaid home health and hospice agencies, hospice care centers, ambulatory surgical centers and certain tertiary services. NCSL notes a 2019 exemption for certain individual or group practice surgical facilities that operated before January 19, 2018; ordinary physician offices and imaging are not listed as CON-covered.
Sources: doh.wa.gov, ncsl.org
Licenses, registrations and state agencies
The Department of Health licenses ambulatory surgical facilities (RCW 70.230), defined as entities whose primary purpose is outpatient specialty or multispecialty surgery, including surgical suites adjacent to a practitioner's office; physicians who perform office-based surgery must also follow Medical Commission rule WAC 246-919-601. No general state license for ordinary physician offices was identified.
Sources: doh.wa.gov, app.leg.wa.gov, wmc.wa.gov
Washington-specific requirements to know
Physicians who prescribe Schedule II to V drugs must register for Prescription Monitoring Program access and must query the PMP at set points in opioid prescribing (first refill for acute pain, transitions to subacute and chronic pain, and periodically for chronic pain based on risk). Ambulatory surgical centers need both a CON and a DOH facility license. PA collaboration agreements must be kept on site and produced to the commission on request.
Sources: app.leg.wa.gov, doh.wa.gov, app.leg.wa.gov
Agencies you will deal with
- Medical board: Washington Medical Commission
- Board of nursing: Board of nursing
- Board of pharmacy: Board of pharmacy
- Business registration: Washington Secretary of State, Corporations and Charities Division
- Facility licensing: Washington State Department of Health
- Medicaid enrollment: Washington Apple Health (Medicaid), Health Care Authority
Nurse practitioners and physician assistants
Nurse practitioners: AANP classifies Washington as full practice, and its state fact sheet lists no transition-to-practice requirement.
Sources: aanp.org, storage.aanp.org
Physician assistants: Since January 1, 2025 a Washington PA must have a collaboration agreement naming at least one participating physician, signed by the physician or the PA's employer and kept at the primary practice location (not filed with the Medical Commission), and whether the PA is supervised or collaborates depends on the PA's postgraduate clinical hours.
Sources: app.leg.wa.gov, app.leg.wa.gov
Med spas, injectables and IV therapy in Washington
Washington Medical Commission rules treat cosmetic injections and laser, light, radiofrequency and plasma devices as the practice of medicine. Under WAC 246-919-606, a trained physician must examine the patient and authorize treatment before injections, may delegate only to PAs, RNs or LPNs with a written protocol, must be on site for non-FDA-approved or off-label substances, and otherwise must be reachable and able to respond within 30 minutes. Under WAC 246-919-605, laser and energy device treatments may be delegated to properly licensed professionals under a written protocol, with the physician on the premises for the patient's initial treatment. IV therapy is excluded from the cosmetic procedures rule.
Sources: app.leg.wa.gov, app.leg.wa.gov
Planning an aesthetic or IV business? See how to start a med spa and how to start an IV therapy business.
Step-by-step checklist in Washington
- Choose your structure and check ownership rules. Decide who will own the practice and confirm it fits Washington’s corporate practice of medicine rules. Washington's professional service corporation law (RCW 18.100) lets licensed health care professionals from listed professions jointly own one professional service corporation, and a Washington Medical Commission policy notes that most clinics are owned by organizations other than physicians or PAs and that dictating medical practice to an employed physician would be an ethical breach.
- Form the entity with the Washington Secretary of State, Corporations and Charities Division. Physicians commonly form a professional service corporation under RCW 18.100, owned by professionals licensed to render the same services (with an exception letting listed health care professions co-own one corporation).
- Get federal numbers. Apply for an EIN from the IRS, then a Type 2 NPI for the practice and Type 1 NPIs for each clinician through NPPES.
- Confirm licenses with the Washington Medical Commission. Every physician needs a Washington license. Check the board’s rules for any practice registrations, supervision agreements or office requirements before opening.
- Check certificate of need and facility licensing. Washington's Department of Health runs a Certificate of Need program covering hospitals, nursing homes, kidney dialysis centers, Medicare or Medicaid home health and hospice agencies, hospice care centers, ambulatory surgical centers and certain tertiary services.
- Register to prescribe. Register with the DEA for controlled substances and complete any Washington controlled substance registration and prescription monitoring program enrollment. Physicians who prescribe Schedule II to V drugs must register for Prescription Monitoring Program access and must query the PMP at set points in opioid prescribing (first refill for acute pain, transitions to subacute and chronic pain, and periodically for chronic pain based on risk).
- Set up lab, safety and privacy basics. Get a CLIA certificate if you will run any lab tests, including waived tests, and put HIPAA privacy and security and OSHA policies in place.
- Enroll with Medicare, Medicaid and insurers. Enroll in Medicare through PECOS, enroll with Washington Apple Health (Medicaid), Health Care Authority and start commercial credentialing early, because payer enrollment often takes months.
- Plan staffing around NP and PA rules. AANP classifies Washington as full practice, and its state fact sheet lists no transition-to-practice requirement.
- Launch your marketing before opening day. Claim your Google Business Profile, publish a website with online booking and start ads and content four to eight weeks before you open, so the schedule is not empty on day one.
The national steps are explained in more detail in our guide to how to start a medical clinic, and costs are broken down in how much it costs to start a clinic.
Marketing a new clinic in Washington
New clinics usually fail on cash flow before they fail on care. The fastest fix is patients booked before opening day: a complete Google Business Profile, a website with online booking, local search ads and a few weeks of social content showing the team and the space. We run that launch for new clinics and keep it going once the doors open.
Plan your Washington launch with us →
Sources
- https://app.leg.wa.gov/rcw/default.aspx?cite=18.100.050
- https://wmc.wa.gov/sites/default/files/public/Ownership%20of%20Clinics%20by%20Physician%20Assistants%20MD2015-06%2C%20Reaffirmed%20March%2013%202026.pdf
- https://www.sos.wa.gov/corporations-charities
- https://doh.wa.gov/licenses-permits-and-certificates/facilities-z/certificate-need
- https://www.ncsl.org/health/certificate-of-need-state-laws
- https://www.aanp.org/advocacy/washington
- https://storage.aanp.org/www/documents/no-index/state-fact-sheets/washington.pdf
- https://app.leg.wa.gov/rcw/default.aspx?cite=18.71A.120
- https://app.leg.wa.gov/rcw/default.aspx?cite=18.71A.010
- https://doh.wa.gov/licenses-permits-and-certificates/facilities-z/ambulatory-surgical-facilities
- https://app.leg.wa.gov/rcw/default.aspx?cite=70.230.010
- https://wmc.wa.gov/policies-rules
- http://app.leg.wa.gov/wac/default.aspx?cite=246-919-606
- http://app.leg.wa.gov/wac/default.aspx?cite=246-919-605
- https://app.leg.wa.gov/wac/default.aspx?cite=246-919-985