Provider Demographics
NPI:1316135114
Name:ISSAQUAH SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ISSAQUAH SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:VEILLEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-386-6321
Mailing Address - Street 1:PO BOX 94248
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6548
Mailing Address - Country:US
Mailing Address - Phone:425-313-0776
Mailing Address - Fax:425-313-0771
Practice Address - Street 1:6505 226TH PLACE SE
Practice Address - Street 2:SUITE 102
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8905
Practice Address - Country:US
Practice Address - Phone:425-313-0776
Practice Address - Fax:425-313-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-06
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical