Provider Demographics
NPI:1215082557
Name:AUBURN OUTPATIENT SURGERY CENTER, LLC
Entity type:Organization
Organization Name:AUBURN OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:360-825-4466
Mailing Address - Street 1:1427 JEFFERSON AVE, SUITE 101
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-3649
Mailing Address - Country:US
Mailing Address - Phone:360-825-4466
Mailing Address - Fax:360-825-2064
Practice Address - Street 1:208 17TH AVE SE
Practice Address - Street 2:SUITE 202
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4515
Practice Address - Country:US
Practice Address - Phone:360-825-4466
Practice Address - Fax:360-825-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602061246261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7107824Medicaid
WA7107824Medicaid