1053498758 NPI number — THE MULTISPECIALTY SURGENCY CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053498758 NPI number — THE MULTISPECIALTY SURGENCY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MULTISPECIALTY SURGENCY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053498758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19930 BALLINGER WAY NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHORELINE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98155-1223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-957-8128
Provider Business Mailing Address Fax Number:
206-417-6947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19930 BALLINGER WAY NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHORELINE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98155-1223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-957-8128
Provider Business Practice Location Address Fax Number:
206-417-6947
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VYHMEISTER
Authorized Official First Name:
EDWIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/MEDICAL DIRECTOR
Authorized Official Telephone Number:
206-957-8128

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com