Provider Demographics
NPI:1124467493
Name:UROLOGY NORTHWEST SURGERY CENTER
Entity type:Organization
Organization Name:UROLOGY NORTHWEST SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-275-5547
Mailing Address - Street 1:6005 244TH ST SW
Mailing Address - Street 2:STE 111
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-5400
Mailing Address - Country:US
Mailing Address - Phone:425-275-5555
Mailing Address - Fax:425-275-5590
Practice Address - Street 1:6005 244TH ST SW
Practice Address - Street 2:STE 111
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-5400
Practice Address - Country:US
Practice Address - Phone:425-275-5555
Practice Address - Fax:425-275-5590
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UROLOGY NORTHWEST, PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical