1770564783 NPI number — SURGICAL ASSOCIATES NORTHWEST, P.C.

Table of content: (NPI 1770564783)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770564783 NPI number — SURGICAL ASSOCIATES NORTHWEST, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL ASSOCIATES NORTHWEST, P.C.
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:
1770564783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 3RD ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98002-4035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-833-4050
Provider Business Mailing Address Fax Number:
253-735-5083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 3RD ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98002-4035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-833-4050
Provider Business Practice Location Address Fax Number:
253-735-5083
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
STANFILL
Authorized Official First Name:
PAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
253-833-4050

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1336205 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1107119 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1051069 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1056662 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com