Provider Demographics
NPI:1871777201
Name:SURGICAL ASSOCIATES NW
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES NW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:STANFILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-661-2594
Mailing Address - Street 1:34612 6TH AVE S
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8723
Mailing Address - Country:US
Mailing Address - Phone:253-661-2594
Mailing Address - Fax:253-661-2694
Practice Address - Street 1:34612 6TH AVE S
Practice Address - Street 2:SUITE 110
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8723
Practice Address - Country:US
Practice Address - Phone:253-661-2594
Practice Address - Fax:253-661-2694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7125081Medicaid
WA7125081Medicaid