1841286101 NPI number — GOOD SAMARITAN SURGERY CENTER LLC

Table of content: (NPI 1841286101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841286101 NPI number — GOOD SAMARITAN SURGERY CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SAMARITAN SURGERY 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:
1841286101
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:
1322 3RD ST SE
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98372-3771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-697-5700
Provider Business Mailing Address Fax Number:
253-840-2352

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1322 3RD ST SE
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98372-3771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-697-5700
Provider Business Practice Location Address Fax Number:
253-840-2352
Provider Enumeration Date:
09/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KASMAN
Authorized Official First Name:
GLENN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
253-697-2074

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)

  • Identifier: 7030638 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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