Provider Demographics
NPI:1104951565
Name:SOUTH SOUND COMMUNITY COLLEGE
Entity type:Organization
Organization Name:SOUTH SOUND COMMUNITY COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP FOR ADMIN SVCS
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-596-5268
Mailing Address - Street 1:2011 MOTTMAN RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6292
Mailing Address - Country:US
Mailing Address - Phone:360-596-5295
Mailing Address - Fax:360-596-5707
Practice Address - Street 1:2011 MOTTMAN RD
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-6292
Practice Address - Country:US
Practice Address - Phone:360-596-5295
Practice Address - Fax:360-596-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty